I'd suggest including the differences in the $75 vs $150 tiers without having to submit a job.  Would be kind of nice to know what you get for what money, or how much you'll be charged before you've given all the info away.  Other than that, I kinda like the design of it, would prefer a country/state/city type dropdowns for location instead of just a "location" entry (but allow a textbox for like, zipcode).