Design a landing page for promotion on website

We need you to create a landing page for furniture deals. I want to have a have a separate URL for each one to avoid confusion. The fields I need on the page are as follow. Name Address PIN Voucher number Phone number Email address (for my database) What product they are after (if there is an choice involved...a drop box can be good for this) All of this info should go through to an Excel spreadsheet to make life easier for me. I need this task completed by Feb 4 Saturday evening Australian time.