Simple Landing Page Design Needed

This project received 40 bids from talented freelancers with an average bid price of $72 USD.

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I need a very simple landing page designed for me. It must have a form included that you will setup on my hosting account..also have it setup with a video embed. I DO NOT need you to make a video..I just the design to include the frame for a video I can put the code in when I have the video.

See attached example for the layout idea I have. As you can see it's very simple and shouldn't take the right person long to make this for me. I want the page and design to be very web 2.0 ish and professional.. You will create the graphics and html design probably from PSD to HTML.

The example is NOT what I want you to reproduce..I want the LAYOUT to be similar to it..that's it..YOU design and create the professional theme, colors etc.

Also any INPUT for ideas on layout or design..let me know.

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