Need some form changes and php work on a Laravel site

I have attached the job spec in an image. Please read through and make sure you understand. Reply to me with porcupine6998 so I know you ready the spec. Currently the site works great, but this form is not user friendly and we need it to work the way we describe in the job spec attached. We are looking for a long term working relationship so if this job is done well we have work for the next 2 years.