This project requires a single web page mainly consisting of a web form designed by an experienced designer. I will provide the winning freelancer:
1. The main web site URL: The page you design will be integrated into this site, so the corporate colors should match.
2. A sample page from another site: This will be an example of the page you are going to design
3. The form elements I need to be used: I need some extra fields that are not in the example page above.
You will *not* copy from the sample page I will provide, but use it as an example only. Your design must be original and should match the logo and the corporate colors of the existing site. The form is very simple and should not take more than 2 hours for an experienced designer.
I prefer Twitter Bootstrap to be used, but it is not a must if you write clean CSS.