Simple update website form

Simple update website form

here's the particulars of what I'd like.

We need to build a form to update the elements/fields on this page

this is the page.
http://template.qbprocessing.com/about-us.html



Avatar (image of face)
Your Name
Years in Business

Business name
Street Address
City, State, Zip 
Free Initial Consultation
Phone: Phone Number
Fax: Fax Number
Email: email address
Web: BusinessPhone Number

Then be able to update the bullet points under these "headers"

Professional Credentials
Certifications
Industries Supported
Products Supported

be able to update the text under these "headers"
About Me and My Practice
Services Provided

be able to update the "Connect with us" social links.
The "connect with us" social buttons are on every page in the site and would need the form to "update" these elements/fields (to the individuals unique social link) on all of the pages (something like 14 pages) outside of the "about us" page

Put two hidden fields in the form that tell me the url its coming from and put a time/date stamp.

The "connect with us" buttons are on every page in the site and would need the form to "update" all of these pages (something like 14 pages) outside of the "about us" page

Update "header image" on the top of the pages in the site (the same 14 pages)

In short
The form should have around 19 fields to update and 2 hidden fields

Needs to be done by Friday 5pm United States Pacific Standard Time

email me "how much" you'll charge

Rick