Selling I want to BUY 2 Opt-In Box Design NO Coding $25 Pay out..Easy Money!

I will provide Immediate Feedback to give you the best chance of making a good design. ​

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* I PAYOUT Instantly Upon Receiving Designs​

* I Give constant Feedback to increase your chances of creating winning designs. ​

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I am looking for a designer that can create a full width and single column sidebar opt-in box.​

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Needed: ​

Single Column Opt-Box With Autoresponder coding 320px by 117px​

Add icons in form fields so user knows what the form represents​

Form Fields: First Name Last Name (Two fields on one row)​

Email Address​

Mobile Phone​

(Check box) I would like to receive sms/voice message reminders​

for the Webinar and Exclusinve VIP information and events.​

Country (Dropdown list) ​

City (Two fields on one row)​

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Examples of Designs Needed:​

Sidebar Optin: http://img233.imageshack.us/img233/4838/homelogin2.png​

Quality of Designs Needed​

http://dribbble.com/shots/344627-Sign-In?list=searches&tag=form_fields​

http://dribbble.com/shots/558119-Contact-form?list=searches&tag=form_fields​

(use tooltips from the above example)​

http://dribbble.com/shots/850194-Form-And-Autosuggest?list=searches&tag=form_fields​

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Style/Colors Variations: ​

1. Dark Blue with Yellow "Get Instant Access" Button with red text​

2. Red with Orange "Get Instant Access" Button with red text​

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Opt-in Box Header Text: Register Today For Your Life Changing Webinar!​

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Opt-in Box Text Above the boxes: Enter your details and learn how to Take Your Vision to Fortune 500 Success by usine Next Level strategies. ​

(bolded text is bolded on opt-in header)​

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Privacy Statement: I respect your privacy and have Zero Tolerance for spam. Your Information is safe and secure with me. (image of a lock would be perfect)​

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Time: 48 Hours or until design concept is accepted. ​

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Submit: PM or Forum, Your Choice​