Authorize.net form

In my wordpress site I need to create 1 payment page (PHP) to communicate with Authorize.net and allow the user to submit payments online. The user will submit:

Bank Name : ____________________________
Customer’s Bank’s ABA Routing Number: ____________________________
Bank Account Type: ____________________________ (savings, personal checking)
Bank Account Number: ____________________________

We will be using the “Internet-Initiated Entry (WEB) eCheck.Net” (AIM) feature of authorize.net to process payment.

We will also need to either indicate a success or failure payment message to the user.

Any idea how I can create this php page in wordpress?