Create similar a one page small website

I need someone to create similar HOMEPAGE ONLY of this website- [login to view URL];gclid=CO633KKFlLYCFaFxQgod_RQASQ The mini form MUST be a working form when done and the popup thing at the bottom must work. I'll need the mini form on that page to take users to another page with a FULL form to finish their application. The info from the mini form on the homepage must move and autopopulate on the full application on the second page. This site will be changed into a payday loan website by ME, I just need the site and forms delivered to me and I'll make the graphic and text changes myself. I will provide you the field names for the forms. This must be done within 3 days. DO NOT bid much as this is a small budget project but there is a LOT of work coming soon so this is your foot in the door. I have 20 more sites like this to be done (custom ones, or from templates) very soon so show me your skills.