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Lead capture page creator

This project is now closed with a project budget of $30 - $50 USD.

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Project Budget
$30 - $50 USD
Project Description

I need a web-based lead capture page creator.

This is what I want this software to do:
1. I want this format: [url removed, login to view]
(That's my son's page, so don't worry about copywrite problems.)
2. Templatize the headline, the subhead, the bullets, the call to action, and the optin form code. When the user inputs information and clicks the button, out pops an optin page that looks like the one above.
3. The user then adds their ftp information and the page is automatically uploaded to their domain where they can preview it on their website after upload from inside the software. If they don't like it, they can change it to another template.
4. I want them to be able to choose the style of page with templates that I will provide. They will be similar to the one above.
5. Leave room to add more templates in the future.

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