Modify HTML Page & Submit to HTTP String

Budget: $45 I have a page here: [login to view URL] This page currently submits to Mailchimp API. 1. I need another variation of this page created for example "[login to view URL]", with only a single field to submit. Remove first name, last name. 2. I need the data to be submitted to an HTTP string in the new variation, not the Mailchimp API. 3. I need the layout slightly changed, increase the font size and move the logo. 4. Add google analytics code The string is like this in a POST / GET request : www.example.com/submit.php/id=XYY&mail=xxx The data submitted should be posted via the HTTP request.