Custom Form Development

Hello, Welcome and thank you for taking some time to review my project! First off, let me tell you a little bit about me and this project: I work as a full-time media & graphics director for a fairly small company. I am responsible for fulfilling all art requests, and/or forms of media for a number of groups under the company. At this time, the process in which this is executed is entirely too lengthy/difficult. This form is something I've created to make the way I receive art requests a whole lot more accessible. The art request form will be a live web application for the groups in the company to easily request art. I've attached an image for how I'd like the whole concept laid out, as well as individual images for each block. I've written the full page in html & css. What I need you for: I need you to take the resources provided (images, html, css), and turn this into a fully functioning form. I'd love to discuss this with anyone interested in working with me on this project! If you have any comments or questions, please feel free to ask me. Looking forward to hearing from anyone interested, Adam