Idea on how do generate gift certificate

I have a client – beautician – who would like to generate a gift certificate from their website. The website needs to gather the following information from the visitor (all mandatory):

– Name of gift certificate recipient

– $ Amount of gift certificate

– Message

– Phone number

– Email

There is a limitation with online payment – payment must be received via phone and then the authorised certificate will be sent – with a unique gift certificate ID – via email to the client.

Can anyone suggest an approach here? Should I be using some sort of HTML Newsletter generator or can MarketPress eCommerce help with this?