XML / website coder

Currently, each time a customer makes a service request, they complete a three page word document with the all the service details required. Our operators copy and paste all their answers into software we use (our own software) to continue to process. I am looking for someone to produce a form online (with various field validation) that, once completed and submitted, will create and transmit an XML file of the form data entered to a remote server for extraction by our software.