Build Lead Generation Site And Database

I would like a lead generation page and admin.. I would like the page to resemble [login to view URL] but would like a few mods like in the mortgage type screen I would like to separate mortgage refinance and debt consolidation from eachother and put them on their own line and also make home equity (get cash) and second mortgage separate and add Get Cash after home equity like I have it above. Keep in mind, the pages change per mortgage type selected.. Database.. I would like a database where the admin can create other accounts for people to login, and also hold all leads that go through the form and also leads I inport via excel or comma delimited. I would the accounts created to be able to change disposition like disconnected phone, return lead and it goes to lead return area in admin but has to have a comment before it allows leade return...I want to be able to add, remove or see leads in all accounts and be able to internally email all created accounts...