Need A Custom Form & Payment Gateway Integration

Please see this [login to view URL] page, there is a form please fill in the test data. Also see that when you select Student Grade I to III , the Product Price get automatically filled with Rs.6000. In the same way if you select Grade IV to VIII the Product Price will auto complete itself and show Rs. 8000. After adding all the test data in the Discount Code field add code INTRO10 and click anywhere , now you see the Effective Price will be 10% less then the product price. Now click on submit, you will see another page which will confirm few entries. Click ACCEPT you will be redirected to the payment gateway with the amount payable. Once the checkout is done the admin gets the email of all the details miled by the user and the user gets the reciept. Basically i want the full above workflow in my wordpress site. I hope i made everything clear. If you have any questions please let me know. The wordpress page i want the above form an workflow is [login to view URL] P.S: I will also provide you AtomTech Payment Gateway PHP KIT that you will use to integrate the gateway. Basic Work Flow Of Subscription form: [login to view URL] will fill all the details, so we need form validation for that also [login to view URL] Discount code block will fetch the data from database [login to view URL] the user submit the form acceptance page will appear which will display the whole data of the user with accept and a reject button [login to view URL] the user clicks on accept button he will be redirected to payment gateway page [login to view URL] the payment is done the whole data will be stored in database and a mail will be sent to user.