Custom Search Box

I want to build a search box which is similar to the one on [login to view URL] and have the following requirements- a) The search form should have - search input area with the following placeholder "Where do you want Heating Fuel?" - drop down with the following label"Select Fuel Type" and - "Search" button. b) The input address should be auto-converted to geo-codes. I have already implemented this and am including it here for completeness. c) The fuel_type should have 2 radio button options - "Heating Oil" & "Propane". Only one fuel type can be chosen at one time and "Heating Oil" should be the default. d) I intend to pass fuel_type to my PHP script which will perform a unique search based on it. e) This search box should work in major browsers such as IE, Firefox, Chrome, Opera. It should degrade gracefully in older versions of these browsers. As mentioned, I have already implemented most of this as shown at this link [login to view URL] I need help in adding the drop down to this search. Thanks for taking the time to review my project!