Add form with auto Response and Banner to page

I need a web designer to add a form where people can sign up to receive a gift. This is a quick job I just don't have the time to do it by 12/29 so here it goes..... Requirements: 1. You will need some graphic design skills so you can design a banner for the front page 2. Develop Fill in/Registration form for after the user clicks on the banner. (Name, Address, Email, etc) 3. Email update is sent to Applicant to say thank you for registering and gives them an ID Number sends it to our email to notify us someone has signed up After Registration: 4. They come back to the website enter their ID and receive their gift online and we send notice that it has also been put in the mail 5. We can also email them and let them know their gift is online Send samples of sites you have done. If you have no samples I will not respond. This should be a quick project so don't complicate it.