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The existing web site needs extra page to be created. I do not need HTML or new design for web site. You create UI for new page (PSD) with based on current web site's design. It is more UI work than a design.
The new page will includes: couple of textual blocks with titles, web form with text area and submit button, table with list of information. Check this wire frame:
The project is VERY simple. I am ready to pay 25 USD for it, +25 USD as bonus if you make it nice and fast. There are two main requirements: http://screencast.com/t/3GifEQ87i7
1) No milestone payment unless you show me some progress (no project give up).
2) If you do not reply within 24 hours I cancel project and you get no payment.