Online Form And Data Transfer

Online Form And Data Transfer
I need an online form to capture the information of those looking for auto insurance in the US.

The form needs to have the same fields and drop down options as this one:
http://www.insureme.com/auto-insurance

The data capture pages need to be in the same format as the form above (i.e. 5 pages + thank you page). Custom styling does not need to be done but the layout needs to be the same with placeholder images. A css style sheet associated with the form pages also needs to be provided.

So aswell as designing the form you need to get all the data to populate the drop down menus (i.e. car models, jobs etc).
NOTE: THIS IS THE BIGGEST PART OF THE PROJECT DUE TO THE NUMBER OR VEHICLE TYPES AND COMBINATIONS.
You can either get the vehicle data thorough copying this site manually or by finding somewhere else where this information can be copied / bought.

This data then needs to be passed by xml to this Lead Management system hosted by flg360.co.uk. The xml guide is attached.

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