Create Payment from Webform Select Options

So, I have a unique form I am trying to create based off of a paper vendor sign up form (see attached image). I was wondering if it is possible to create a webform with select options of dollar amounts and then use rules to create a payment containing the total of all the values? Or if there is some other solution to create a webform like I am trying to do without too much custom php? Any help would be appreciated. I have looked all over online and cannot seem to figure out what I am trying to accomplish...