One page web site

Basically, we buy ugly homes in disrepair or help homeowners that cannot pay their mortgage. We need to create a one page web site where we can collect information from people that know about distress properties. So we need to capture: Name, Last name, email, phone number, address of the property, notes section (where people can type anything they desire). Site needs to capture and store this information so we can retrieve the data. Site must send a confirmation email to person who completed the form, thanking for their submission (which is confidential). Site must send an email to web site owners of the newly captured lead(s). The web site once completed must be ready Every person who completes this forms, earns $1000, if the deal closes. So the site must be lively and reflect the helping nature of our business and the $1000.00 reward if the deal closes. TY