CSS / PHP Form Fix (Designs and some usability)

We have a simple web form made in html / css / php. We have some layout isues with it, so you will need to be able to fix the layout issues. A GOOD knowledge of PHP is required also because the php is integrated and may need to be adjusted. This is a simple set of usability changes that are needed as per my document. Project budget is $50 maximum and work needs to be completed in 1-2 hours (by 2pm GMT)