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CSS Popup Login Box

This project received 32 bids from talented freelancers with an average bid price of $85 USD.

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Employer working
Project Budget
$30 - $250 USD
Total Bids
32
Project Description

I need a popup window that looks like the one in the link below but also has 1 (one) form field to:
[url removed, login to view]:&imgrefurl=http://www.designyourway.net/drb/a-collection-of-useful-jquery-modal-dialog-boxes-31-plugins/&docid=ea0vP9TdUhnRVM&imgurl=http://www.designyourway.net/drb/ths/diverse/modaldialog/build-a-popup-modal-window-using-the-jquery-reveal-plugin.jpg&w=700&h=277&ei=zYyBUoehD4WQyAHQ2YDgDQ&zoom=1&ved=1t:3588,r:21,s:0,i:151&iact=rc&page=2&tbnh=141&tbnw=351&start=15&ndsp=19&tx=197&ty=57

I need to be able to trigger this code by either pressing a button or on page load. the idea is that it either (a) prevent the website from loading until a valid input is received or (b) it masks the current page from the user.

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