Create a simple order form

I have a simple questionaire form for the visitor to fill in details like :
Name
Address
City
Postal Code
Country

Some enquiry (containing checkboxes)like :
Home Page : HTML Flash
Logo : Yes No
Feedback form : Yes No

etc....

My query is, when the visitor check the check boxes, some value should be calculated (ie) if he checks HTML, the charge is 5000, for feedback form , if he checks yes, the charge will be 6000 etc and after he fills all the required details, Grand Total should be calculated in a text box which should be invisible to the visitor but visible to the administrator and when he clicks SUBMIT, a copy of the filled in form should go to the visitor and administrator but the visitor should not see the GRAND TOTAL value in the text box but the administrator should see the GRAND TOTAL...

Can u please help me out in this query