Create a Simple Site - 2 Pages

I would like someone to create a basic site for me. The main page will have a navigation bar, company logo/text (top left), Call button (top right ), Search Box and Background image where person can enter their name and zip code. The Rectangular shaded box that houses the name, zip and search fields will have text that say's: "Find a Local xxxx" Enter Your Name & Zip Code Below! [login to view URL] can help you find a local xxxx near you to help with yyyyyy. Our fast and friendly team is ready to help you find a xxxxx near you now. Name: ________(Text Field) Zip Code: ________(Text Field) Find a XXXXX (Button) Below the search box there will be 3 shaded boxes containing boxes with check marks with text next to each check mark & bullet points below it. The Box text will be: Local XXXX, Call Now & Fast & Reliable. The site will ideally be made from Wordpress and be mobile optimized for google purposes. I want the main page we create to focus mainly on getting visitor to enter the name and zip in order to search for a local service provider. Once the search has been submitted I would like the text they entered to be generated on a results page that say's something like: Good News (Name)! We have found (random number) of local xxxxx in (Zip). Call: XXX-XXX-XXXX to speak a team member who is ready to help you connect with a highly rated expert. Call: XXX-XXX-XXXX Now! I would also like a widget on every page that enables the user to enter their Name and Zip so this results page can be displayed. An example image has been uploaded for your reference. Previous projects and work samples are a must. If you do not have work samples, please do not apply. Thank you.