Custom Checkout For eCommerce Website

Need a custom checkout for my a eCommerce website. I need to run all credit card transactions manually so i need to set up the checkout to were the customer fills a custom form out and sends the information to me. I have not set up a website yet because i wanted to discuss what the best website builder was in terms of customization. Want the checkout to run smooth and look professional, just like any other checkout process. Looking to start immediately, if you have any question please feel free to PM me. 125.00 is my budget for this project