basic PHPLIST form & configuration

I consider this project less than 2 hours work so bids over £60 will not be required We need a form created on an html webpage for use with PHPLIST The form will have three text boxes for subscribers "name" "email" & "organisation" The form will also have four checkboxes - 3 of the check boxes (if checked) will send the subscriber an email with information that they have requested (when they click submit) and the fourth check box will be to sign up to a news letter After they click submit they will be forwarded to a page confirming what they have subscribed to and then they will receive the emails for each subject that they have checked the box for / requested A page for un-subscribing to the newsletter will also be required No reference to PHPLIST should be seen at any time during the subscribe or un-subscribe process This can be setup on a test server and then transferred to the actual server after testing Please only bid on this project if you are very familiar with what I am asking for Re-posted as last freelancer was unable to complete the correctly working project! Payment will not be made until the project is finished and tested If you need any further clarification, please ask.