ADD FORM TO SITE FOR AUTO-RESPONDER SERVICE

******I have a website and I have an email Auto-responder service, I need an Auto-responder form to appear on the main page of my website.? Also, the site is currently blank so I may also need a basic webpage created.? This form will be the main purpose for the webpage.? Everything else on the page will be text (a paragraph) and perhaps some graphics.? I need this form created and added, can you assist?****** ## Deliverables To get a perfect idea of what I would like the FORM to look like, please visit the site " <[login to view URL]>" to get an idea of what I would like to accomplish here. Also, the site will be called "speedyhomepurchasers", so I would like to incorporate SPEED on the page (perhaps fast car, lightning leading to $$$ graphics/money).? Perhaps a fast road and a pot of gold/money at the end. These are images and themes that may go well with the site name.