Where can i buy a good webhost order form ?

I just want to good order form , i don't need any billing system .


When client fill the form and choose a product , it will count the money automatically .

and the send welcomeemail with information for admin and client .



Any idea ?

Budget 10 ~ 50 US

with this price whoiscart.net, u$s 35

Check this;

http://www.phpcube.com/product_info.php/products_id/35