Hello,
I have a few questions:
1. You mentioned that the form will be 6 pages and the form to look like the form you attached. Is it 6 pages with each form like the one you attached? Or is it the form you attached divided into 6 pages?
2 You mentioned a secure location. Do you want the data that is submitted to the secure location displayed like the form you attached? Is this 'secure location' already existing or needs to be created as well?
Note:
The signature field can will be created accordingly, where people can sign vial mouse, or if it's a touch screen, a styles pen or even a hand (finger) :)
About me:
Full-time freelancer since 2007, with proficiency in HTML, CSS, PHP, MySQL and Wordpress. I like this kind of projects as it gets my mind working.
Looking forward to getting some feedback from you soon.
darkwind