Create pullout web form

We need someone to create a "pull out"mailing list signup form similar to the one used on the [login to view URL] website. This form should have vertical tab to display a message. The tab should remain in place when the page is scrolled. When the tab is clicked (or optional mouseover), it should pull out and display the form. You should supply javascript and css in the form of a widget that can be inserted in a website page. The code should be flexible enough that we can customize the size of the tab, insert html for the message, add custom images and backgrounds, etc. I know the example pull out form uses Mailchimp, but we are not using Mailchimp and need code that can be used with any mailing list software.