Need for a Webpage to be designed for a competition with a mini store to link to an website

Seeking some to design a webpage to link on an existing website for a competition. The Competition / Event : We are a social group based in Dubai and are seeking for someone to design a page for our new event ‘Happy Coins’. The project is where people from around the city can nominate individuals that they feel go beyond their 9 – 5 jobs to help create a better society by their deeds and contributions. Ever nomination will be reviewed internally by us and the ones that seems well in line with the theme of the event will receive a set of happy coins (physically delivered to them) through which they can shop at the same page for different gifts. Every happy coin will have a code at the back labeled that they can use when selecting a gift to order from. The ordering process looks something like this. Segment 1 (refer page attached): A mini form that allows the users to details their nomination & why they feel they deserve this surprise. The form should include details such as Name, Details of the nomination, mobile Number of the nominee, Address of the nominee (if available) & a personal message if any. All these elements need to be next fields with no world limits. Segment 2 (refer page attached): (refer page attached) : A mini store for the nominees once they have received the happy coins to place an order. Every nomination is reviewed that was filled on segment 1 and the ones that are found worthy of the coins are couriered with the happy coins (50 – 500 in value where each coin holds a value of 50) depending how big their contribution is. The store will be merely a single section with no indepth breakdown of the gifts. The gifts are not yet decided. Every gift/item will have 3 buttons under it – the - Add - A button to add the item to the cart based on the number of points it holds. - Qty – A number field for the user to add the qty of the gfts he wants for the selected - ReadMore – a popup text field that can show a small description of the selected gift. On the footer of segment 2 will have 2 details shown. - Total Value: A total value of the coins the user will have to use to get the selected gifts. This will help the user better decide on the selection he has made. - Checkout: Once the user has decided on the cart – the option to merely checkout and move to the payment field. Checkout Page: Here the user has to tally / pay of the cart he has acquired. Depending on the value of the cart – the user will get an option where he has to detail the key that has been typed on the back of the coin (note each coin has a value of 50 and each of them has a unique key labeled behind it eg: QYTVP) . The form must be able to validate these value based on a background database of these reference and once it registers all the keys as valid – the use should get an option to proceed to ORDER. ----- This created webpage will be added to a website that I have on wix under pinkmangoproject