You'll need this script.

Booking a remote help appointment.

Please place your date and time of your appointment, please give 2 alternatives.
Prices: 0-1hr $35.00, 1-2hrs $60.00, 2-3hrs $90.00, 3-4hrs $120.00

 Preferred Date/Time use format 10/01/2008:10.30am

 1st Alternative

 2nd Alternative

Estimated Time: