Write a script for sending an application to the mail

You need to write a script for sending an application to the post office (a simple online evaluation of cars) (you can remake existing ones)
When you click on the button on the site, a form with the following fields should pop up:
1. Car: No damage, broken (list)
2. Make and model of the car (text field)
4. Engine (gasoline, diesel) (list)
5. Engine capacity
6. Type of transmission (Mechanical, automatic, robot, variator) (list)
7. Photo of the car: (the possibility of attaching the document)
8. Your Auto Assessment (Digital Field)
9. Note
It is necessary to check the correctness of filling the fields
After clicking the send button, the following message should appear: Thank you for the application, you will be contacted soon. After 3 seconds, redirect to the main page

A better correction of TK is possible
I am looking for offers on price and other points.