Small google wildfire liquid script needed -- 2

Avg Bid (AUD)
Project Budget (AUD)
$10 - $30

Project Description:
I need a script written in google liquid for wildfire -

I need a page that on page load has a single numeric entry field .. if the user enters 12345 then i want the page to display a simple form where they enter an email address

Skills required:
HTML, Software Development
About the employer:
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$ 94
in 6 days