Build a Website with responsive designs

I have a project that I want to get completed in the next two to three weeks. It is a two part form, for potential home sellers to fill out. If you do not answer the questions I ask I will automatically decline your application. The first form is for someone to enter their address. This address is verified by google. So when they start to enter their address it is checked by google, and they click an address that google suggests. When they hit the button it emails me their address, and takes them to the next form. The second form shows a google image of their home, and asks them where we should send their valuation, When they complete that form it emails me their information. All of the fields are required on this form. I want the form to auto submit to me when they complete a field, and NOT when they hit submit. I would also like it to have a hidden value that carry's the address over from the first form to the second and sends me that address, so I know what home their information is linked to. After this they are taken to a simple thank you page. I may want to have the ability to embed a video, set to auto play on that page. You can see the process at [login to view URL] I need to be able to easily change the background image, and duplicate the form for multiple sites. I will have the same set of forms for each city where I work. So [login to view URL], [login to view URL], [login to view URL], etc...On each page I will change the text, and the picture, and place a new video on the thank you page, etc... I want to be able to modify the pages you set up, and copy them to new sites easily. I will create the duplicate pages using what you have created. You would be creating the first one, and telling me how to duplicate it to other sites. I am fine having this done in wordpress, or joomla, as long as I can easily copy it, and create new sites from it. Please tell me what your fixed cost would your cost be? How long would it take you to complete?