Tow Booking & Quoting Form Development

I'm looking for a developer who can implement a quoting and booking form on my website, similar to the one on https://wil-tow.com.au/book-a-tow.html, limited to cars and motorcycles. This form should calculate the towing cost based on distance using Google Maps and also include a separate service for "Roadside Breakdown".

Key Requirements:
- Cost calculation: $199 including GST for tows <10km’s, $6 including GST per km > 10km’s. For example, a tow of 20km’s would be $199 (for the first 10km) + (6 x 10km) = $259 incl. GST
- Separate service for "Roadside Breakdown": $99 including GST for a call out within Metropolitan Melbourne
- Users should receive a confirmation email after submitting the form, containing all details
- The form should provide a detailed cost breakdown before submission

Additionally, I would like the form to allow users to schedule a tow for any future date and time.

Ideal Skills:
- Proficient in web development with experience in creating interactive forms
- Familiarity with Google Maps API for distance calculation
- Good understanding of e-commerce, specifically in calculating and displaying costs

Please provide your quote for this project.