Add page for secure payments to existing site(repost)

I have a website at <[login to view URL]> that I want to add a secure payment page to. Throughout the year, but mostly just before and duriing our February symposium, we take payments for annual membership fees, fees for attending the symposium as a vendor and as a CCME member and for the banquet. I have added a copy of the Word document that they used at the door last year for to register vistors at <[login to view URL]>. We already have a merchant account with Bank of America and in the past we have filled this form out and used a credit card slide machine to run the slips, then mailed them into BOA. I want to put this online. I am familiar with HTML but not this type. At <[login to view URL]> is information about using BOA branded Settle Up online system along with the developers code. I think that would be the best system for what we already have. ## Deliverables 1) I need a page that is complete and functional but does not need to be formatted as far as the fonts, background and layout are concerned. 2) I need to be able to make changes in dates and in prices from year to year. 3) Basically, I need an electronic version of the sample form. Looking at the form, I need the symposium fee to be one price up to a certain date, then change to another price after a certain date, or both choices can be visible, but the lower prices becomes unselectable, or both prices are in a dropdown but the lower price is not selectable after the cutoff date. (1-9-04 in this case). 4) The one-day symposium fee has radio buttons for the day to choose from. 5) I need the ability to add up to 6 misc additional items (the form has 3, two for meals and one for a winery tour) and I need to be able to put the price in for each. If there are no additional items then that field should be hidden. 6) The sponsorhip/exhibitor area is self-explanatory, I will need to be able to change the price on them. 7) On this form there are 4 yes/no questions on the right, I need six on the webpage using radio buttons for the selection. 8) I need to collect the same information about the person as is listed on the right side of the form. 9) Obviously, I need the credit card info to go to BOA for verification and for the person to get his confirmation number for the transaction. 10) For our newsletter and membership roles I need all data submitted, except the credit card numbers/exp date, to be written to an Access database. 11) I would like a separate price for the ability to automatically printing on paper about 3 x 5 inches the persons name, title/rank, organization and for one-day visitors the day that they paid for. a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform This page will be on a web host running NT with FrontPage.