Create a pop-up form integrated with mailchimp

I need a signup pop-up form that I can put on any page in my site that integrates with mailchimp. ********************************** IMPORTANT ********************************************** Read this whole description prior to bidding. I will NOT pay if a freelancer is unable to complete all items in the Requirements List. ************************************************************************************************* EXPERIENCE - Must know javascript, HTML, very well. - May need JQuery skills. - Must know and be familiar with mailchimp forms REQUIREMENTS 1- Take the form that I give you, (which is provided from mailchimp) and write or adjust the javascript code to work on my site. 2- The code must be portable so I and put it on any page in my site. 3- The pop-up must have a delay. 4- The pop-up should have the ability to detect if a user moving their mouse to the Back Button or the (X) close button and pop-up. 5- Variable locations for popup. 6- Must integrate with mailchimp which means that when a user enters email and first name and clicks "Request Training" button, it directs them to a new page. (Exactly like a non-popup form that is already on my site) 7- The code must have parameters (which can be in the code)so I can adjust the following: A.. The delay - how long it takes to pop-up. B. Mouse moves on the Close or Back button - Turn this feature on or off C. Location - setting to select where the signup form pops up. LIMITATIONS & EXPECTATIONS - You will not have access to my site. (Sorry but the site is a specialized elearning site that limits access to backend files) - Each webpage is wrapped in a form wrapper. The javascript must be able to work within this form-wrapper but there are options to working around this limitation. - You can use all the browser tools available to you to look at the code. ie firebug, Inspect Elements, etc. - You will write the code, I will put it in place and test to see if it works. - We setup a time and we can work together when your code is complete. Send me code, I put it in place, we test, you tweek the code, I replace code etc etc. Until it is correct and works. ALLOWANCES - The main requirements are 1, 2, 3, and 6. If you find it too difficult or time consuming to do the others, we can negotiate a reduced price for the minimum requirements. FINALLY Ask Questions - Before bidding and during project. Don't Assume. Communicate well. Thank you for looking