Immediate disability rates

OVERVIEW: We need website code written that will accept several inputs from the user and - after the button is clicked - display rates. Very similar to [login to view URL] ABOUT US: We sell insurance to doctors. [login to view URL] is our website. Requirements: * All code should work seamlessly on desktop and mobile devices, including iOS and Android with Safari, Chrome, IE, Firefox browsers. * The code should accept user inputs: first name (optional), last name (optional), email (optional), cell (optional), sex (male/female), age (26-40 - may change over time - must be editable by us), smoking status (tobacco use, non-tobacco), and specialty (defined list that may change over time - must be editable by us) * Based on the user's inputs, the code should display outputs: there will be 7 companies listed. Each company will have a price quote unique to the user inputs of 6 characters (such as 123.45), a link to a pdf file (specific to the user inputs which opens in a new window), and a link to a second pdf file (company specific; opens in new window). - the companies should be listed in order of their price (lowest to highest); the lowest should be highlighted * We should be able to update the rates and pdf links via a .csv (or similar) file. We expect to upload a file similar to the attached - note that there are currently 48 specialties. We list each specialty by age, gender and smoking status. * must be wordpress compatible; our site is [login to view URL] * we must be able to add this code to other pages on our website. As we create new landing pages, we will want to add this code to these new pages quickly and easily ourselves. * if possible, we would like for this code to be simple enough for us to easily copy/paste to other websites we may develop in the future. for example, html code that can be copy / pasted into to another domain.