523409 Placeholder webpage with email submission

I'm looking for someone to build a placeholder page for a site. It'll have the logo with a couple of lines of text below it, two small paragraphs of descriptive text and a submission form for sending their email address to be notified. I will need there to be some sort of verification so that it appears to be a legitimate email address that was entered into the box. I have a link to a site that I've seen that I like... I'll share it in the PMB to potential programmers. I don't want to copy it... just use it as a basic guide to the layout. Please be able to create and not just copy! Looking for fast turnaround!