Need simple form design

I need a form design for a system management interface. The design wneed to be based on this:

http://www.webdesigndev.com/wp-content/uploads/2009/07/74.jpg

Let me know your pricing & time taken to deliver.

Cheers,

 

psd or coded? and $5 for psd

 

I need it as a web template. Another thing I also need at the end of some of the fields, there will be a help icon. And when I put my mouse over it / click on it, it will float a small help box for text explanation.

FYI I don't want all this floating on some other website. Instead I need it to be its own page itself. The only one floating is the help box mentioned above.

 

if will accept psd heres version of it - ofr you could get it coded by someone else -*edit* just seen your comment - well i cant code it oh well.

 

cool, nicely done.. I know with this design it is easier to cut it into pieces using fireworks, but I need some one to do everything for me.. I think with the involvement of css is much better. Anyway thanks... so anyone else care to take up this project?

 

I'll give it a try later today, probably a few hours time. I'll try coding it, I'll let you know what the price is once I'm done.

 

Cool, but one thing, that is just a sample design. In actual fact the full design will consist of few form fields.