3 Step Cross-Platform Form Requiring Coding - repost

We are after an attractive 3-step cross-platform web form with validation for a PHP site to be coded as illustrated in the attachment. The key part to the form is the slider in the first step which must function not only on desktop browsers (IE7+, Chrome, Safari, Firefox) but on all mobile devices particularly iOS and Android. The following 2 steps to the form consist of inputs and custom illustrated radio buttons. The form must validate all section with the backend options to disable the validation on individual form elements. The form must be portable, so that it can be reused in other projects. We are looking for an attractive default css style, with attention to details such as how error messages are displayed and smooth transitions between the 'steps' of the form. Form labels should sit on top of sliders and radio buttons but within the input for text inputs. Once the form has been submitted, the form should go to a thank you screen (editable url), and submit two notification emails in both html and plain text. One to ourselves (multiple recipients) and one to the customer who completed the form. The slider on the first step must predict an outcome as illustrated by the formula below =(TotalDebt /(MonthlyPayment-ManagementFee)) Management fee is calculated by MonthlyPayment * 0.175 Finally the 3 step form should have instructions provided on how to add further form fields and steps plus its associated validation. We will be happy to supply more information should it be required