JQuery Dialog HTML Tableless Form

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Bids
10
Avg Bid (USD)
$71
Project Budget (USD)
$30 - $100

Project Description:
I have an ASP.NET MVC application that uses JQuery Dialog feature. I need to have my JQuery Dialog Forms looks like the attachment File.

NO TABLES.

I need to have this CSS Framework to be applied in all my JQuery Dialogs, so this is an example but the form can be different between dialogs.

Skills required:
CSS, Graphic Design, HTML, jQuery / Prototype, Website Design
Additional Files: dialogform.png
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