Create Webpage Design & Submit Form.

I am looking for a very attractive webpage design, and submit form. I am looking for the design to be very professional, attractive, and clean.... I place vending machines at business locations, so the website has to address that I offer vending placement at no charge to the business... the site also needs to have a nice contact form on the first page as the website will only be one page. Business Name Contact Person Business Address City State Zip Phone Email: I also have vending images that can be used so the business can select which vending machine they want, and what candies they want in the machine. These images need to be selectable so when the form is submitted, then I will receive via email, exactly what they want placed. the webpage needs to impress the business owner, enough to call me and say, I want your vending machine at my business location.... a nice size header for the website would be good also, and once again, it has to impress... can you design to impress? any questions? ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform php, html