Freelancer

Description

I am looking to have a single page "secure payment form" that can process a payment via Authorize.net. I would like it to be a secure (SSL) connection and auth/decline codes displayed (approved, declined,address mismatch street/zip, cvv mismatch). I would like the account information in a separate configuration file (config.php) where the authorize login and pw can be stored and I can modify.

I would like the form to include:
First Name
Last Name
Billing Address1
City
State
Zip
Phone Number
Email
Credit Card Type (Master Card/Visa/Discover/American Express)
Credit Card #
Credit Card Expiration
Credit Card CVV Code
Submit/Reset buttons
Authorize.net Seal and SSL Seal (which I can add myself)

once order is submitted email should go out to admin and a thank you email to user

here is the design for the form

hmcholdings.net/sinsafely/charge.jpg

this needs to be integrated in to my joomla website! VERY IMPORTANT it MUST look like its part of the website

if you have examples of something that you have done similar its a plus.

must be integrated using AIM method