Acrobat Form

I need an existing Acrobat Form credit card authorization form modified so that clients can complete on line and submit by email OR print and fax to us. 1. Form must validate the credit card number using industry standards to identify a credit card number that is wrong or has the wrong number of digits. 2. Form must have a place where a submitted date is inserted at the time it is emailed or printed. 3. Form must be locked once emailed so that it can not be tampered with at the recipients end once received. 4. Before submission is allowed the form must be signed electronically. Not all users will have a digital ID (or the ability to create one) so I am looking for another solution to signature.