Looking for a contact senator plugin

I have an excel spreadsheet of states and their senators (columns=senator 1 lastname; senator 2 lastname; state abbreviation; senator 1 email address; senator 2 email address). I’d like to create a plugin that would have the user land on a page where they then select their state. Once they do, content will dynamically display listing their senator’s name and position on a particular issue, with a form asking for the user’s names (first, last), email address, zip code, and then a body field with suggested text that they can edit to send to both of their senators.