Custom paypal form

I require a single form, a form that will allow users to enter the following information: first name Last name email address address (residential) Country Dropdown list for states post code currency radio buttons with 6 different donation amounts and an other field for a custom donation radio button for one time donation or a recurring donation These fields need to be wired up ready for PayPal so all I need to do is enter the PayPal details and paste the form on to the aspx page. I would prefer for this to be done in c# and asp.net 4.5 Deliverables ASCX page (user control) C# page PDF with brief and concise instructions. Expectations I expect the code will be fully tested with PayPal sand box, the code to be clean.