Subscription Form AW

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
Need a subscription form created. Want it to look similar to Goat.jpg but where the person is I want a goat and where the DVD's are I would like something that looks nice for newsletter and free report series.
Needs to contain the fields in form Bed2. Width is the same as Bed2 I think it is about 380 Pixels but check it. Length can be similar to Goat. Questions Ask.

Will need a second form same but for different site later.

Skills required:
Graphic Design, Illustration, Photoshop, Website Design
Additional Files: goat.jpg Bed+2.jpg
About the employer:
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