Need Simple Module Built

[point4design]

I have a simple module that was built for me that collects some information and collects the payment via authorize.net. I need a second module created that will do the exact same thing but I need to collect different information in the form. You can see the existing module here:

https://www.sthelenas1712.org/index.php ... tributions

This is time sensitive and I need it done quickly so please only respond if you can start right away.