Basic Landing Page site needed.

I want to create an information product about Potty/Toilet training. In order to test if there is enough interest to warrant developing this information product I need the following. 1. The creation of a very simple 1 page landing page to get responses to a question. the page needs to only stay online for the duration of the pay per click campaign. 2. Traffic drawn to the site with a 5 day pay per click campaign. 3. The responses emailed to my email address. Breakdown 1. I need a very basic 1 page landing page website set up for 5 days where people who are searching for advice about potty training can be directed with pay per click (PPC) advertising. The site will have the following text on it; Dear potty training parent Thank you for reaching my new website. I have just finished potty training my son and now I want to help other parents with their potty training experience. So I’m writing an e-book on how to potty/toilet train a child and I need your advice. Could you please tell me, In your experience, what are your biggest questions or frustrations about potty/toilet training a child? Plus, would you be interested in hearing other parent are experiences with potty/toilet training? Your feedback is very valuable to me. So as a gift to say thank you for taking the time to leave your most pressing question or frustration, I will happily send you a free copy of the e-book ($27.77) when it’s finished, to the email address you listed. Kind Regards Saara Burger Queensland, Australia Below this text box I need a simple form where respondents can leave their Name, Email Address, Country/State and Question. Have enough space under the question or frustration section to have a 10 line answer. Potty/Toilet training Question or Frustration Name: Email Address: Country/State: Question or Frustration: Thanks again and expect your free e-book in your inbox when it’s finished. Saara Burger ## Deliverables The only images I require on it is a nice border and a picture of a potty, or a nice picture of a child on a potty. Make the background a pastel blue, make it something warm and fuzzy that Mums would like. The most important thing about the site is, that it requires that visitors to the site are able to easily leave a response or answer to my question. There must be some way to capture their email address so I can send them a free copy of the completed report for their feedback. Plus include at the bottom a standard privacy statement I need the responses to be able to be forwarded to the following email address: theburgercrew@[login to view URL] This email address can’t appear on the website. In regards to the (PPC) Pay Per Click advertising, I need the PPC advertisement on the right side of the screen to run for 5 days. My budget is $40.00 for the 5 day campaign. However, I would value your feedback and advice in regards to this. Here are my three main advertisement headline suggestions 1. Free Potty Training e-book Your biggest questions about potty training answered? www. 2. Potty Training Frustrating? Your biggest questions about potty training answered! www. 3. Potty Training questions? Your biggest questions about potty training answered! www. Any other suggestions would be appreciated. I am looking for a vWorker who has solid understanding and experience with website set up and design and PPC advertising. If I am happy with this work, then further ongoing work will defiantly be offered, such as ebook design, formatting, etc... In regards to bids, I am open to reasonable suggestions. please email me on david@[login to view URL] if you have any questions.