387995 Need PHP form edited

I have a current form that allows the user to enter information and upload a picture. I need the form fields edited and I need when they submit the form instead of going to paypal it will just email the information and pictures to an email address and return to a page. Change company name to "Full Name" remove business category change county network to "which state would you like to block" remove add text remove membership selection add 2 additional upload features so they can upload a total of 3 pictures. add a check box and say "I require a FREE web camera" change the check box to continue text to say "By checking this box I agree I am of legal age of 18 years old or older. I understand that I must provide a state ID to prove legal age." must be completed whith in 1 day of acceptance or a full refund will be provided. The form needs to beable to work without connecting to a database and just its own form.