Simple leads page needed

I need a lead page that looks like this [login to view URL]

I have the image for the background, and the text. Basically I just need you to put it together and add a spot to gather the visitors name, and email address. That info will then be emailed to me. I want it to be simple and without having to give access to the cpanel. This page must be mobile friendly as well.

Skills: Graphic Design, HTML, PHP, Website Design

See more: want buy fresh email address, virtual assistant needed generate leads, likes needed page, page checkout creloaded shipping billing info problem, usa loans needed people leads, javascript needed page, proof reading time needed page, 1st page leads, javascript support needed page

About the Employer:
( 91 reviews ) Fergus, Canada

Project ID: #9267444

Awarded to:


IMPORTANT/ I CAN START NOW, AND FINISH FOR MAX ONE HOUR PLEASE IF YOU LIKE MY WORK AND MY SITE DESIGN CONTACT ME FOR MORE INFO. Hi, i am frontend developer with 3 years expirence, you can check some of my work so More

$25 USD in 1 day
(131 Reviews)

11 freelancers are bidding on average $20 for this job


Hi sir, My name is niranjan, I am ready to start right now this is a simple job for me, I love web site design and development and have great portfolio with different type of work, please come on chat to discuss mor More

$25 USD in 1 day
(74 Reviews)

Hello Thanks for giving us a few moments of your valuable time! We are an IT company having expertise in Website Designing, Software Development and Mobile Apps. We have a team of dedicated PHP, ASP.Net, Android and More

$20 USD in 2 days
(39 Reviews)

hi I m ready to make exact page and that will be completely responsive

$20 USD in 0 days
(66 Reviews)

We are php experts, you can see my profile for more info [login to view URL] [login to view URL] [login to view URL]

$20 USD in 1 day
(1 Review)

Hello, I have read your posting job carefully. I am looking for a job like this. I can do your job perfectly and also assure you that my work will be 100% satisfied to you. ALso the page will be 100% responsive t More

$25 USD in 1 day
(1 Review)

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$20 USD in 1 day
(1 Review)

Hello, Thanks for providing this opportunity. I read your advertisement carefully and want to offer you my services for this job. I have been in this industry for 5+ years and such jobs are my daily practic More

$25 USD in 1 day
(0 Reviews)

Hi there, Hope you are doing Great !!! I read the Job description and can complete this job . 1. Great knowledge and experience in following skills: - - Strong hand on OOPS, PHP/MySQL, and Git. - Ajax, Jquery More

$19 USD in 1 day
(0 Reviews)

I put my bid in as cheap as possible because I'm looking for my first review. No one will even consider you unless you have at least one, and I'm hoping you will give me that chance. I'm a Ohio, USA native and have More

$10 USD in 1 day
(0 Reviews)

Hi I hope you will be having a great day. I read your project brief and found that I can provide you best service.I am expert of html can do your work in an hour and I am new here so offering very cheap service. I gua More

$10 USD in 0 days
(0 Reviews)