474723 wordpress plugin needed: price quote generator

i am working on a wordpress site for a moving company. i need to add a plugin that will generate a price quote for a potential customer who visits the site. the customer would need to be able to input: current zip code, new zip code, moving date, and other pertinent details - plus, they would need to check off what pieces of furniture need moving (or have a box that they could input numbers to show how many couches, beds, etc). the plugin doesn't need a shopping cart - this should just generate the quote and if the customer is happy with it, they would be put in touch with the company for the actual scheduling and payment. here is an example: [login to view URL] (on the right sidebar) please let me know if you have any questions.