Need: Minimal One page product checkout with basic fields only and offer code verification

[HostMaria]

Good afternoon,

I am looking for a quote for a following module: Minimal One page  product checkout with basic fields only and offer code verification.

Will be used for this product https://www.hostmaria.com/cart.php?a=add&pid=1

The module is needed to meet needs of AppSumo requirements. https://www.youtube.com/watch?v=-4DdLeI5Lww

Logical structure:

1. Client comes and fills in custom signup form:
   1. first name
   2. last name
   3. email
   4. chooses password / confirm password
   5. primary domain name (necessary to set up the product)
2. Verifies unique offer code (pregenerated by us)
3. Code is verified > clicks a button and completes registration
4. WHMCS adds the purchased product https://www.hostmaria.com/cart.php?a=add&pid=1 to his account where:
   1. billing cycle = 1 year
   2. 1st year is free (gets invoiced after a year)

Notes:

• No card details are asked (nor any other payment details)
• The checkout is for new customers only
• The code verification button is optional - v2 > if wrong coupon code is entered, notification can come up: "Please provide a valid redemption code"

Here is a quick sketch:

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I have made several attempts to get quotes. Please quote me your price here of individually and the time frame.

Looking forwards,
Helmuts

[HostMaria]

Job given to @RactStudio. Thank you all. Best wishes, H