Design, Develop 1 static webpage with sign up form - repost

Hello - I need a fantastic static page designed and set up that includes a sign up form. I have recently launched an e-commerce website www.kukucloset.com. I need a separate static page designed with a sign up form for customers to sign up for $10 Free Gift Card that they can use in my store for purchase. Idea is to basically, have this page exclusively for potentials and interested people to sign up and receive a $10 free gift card to shop with my e-commerce website. The page will need to be excellent looking, have great image of real gift card image with my site logo etc... I'm sure you know what is needed (as i don't)...The site should be designed to entice customers to sign up for the gift card...(no credit card info) but just simple sign up (with name and email address, physical mailing address with state and zip), check box for terms and conditions and receiving offers from us etc. THE PAGE WILL NEED TO CONTAIN A BEAUTIFUL IMAGE OF A PLASTIC GIFT CARD WITH MY LOGO AND POSSIBLY A JANE DOE NAME ETC. I'M NOT GOOD AT DESIGN. SO I'M LOOKING TO YOU TO COME UP WITH A GREAT DESIGN USING YOUR SKILLS TO ATTRACT PROSPECTS. FEATURES LIKE CALL TO ACTION; GREAT IMAGES, GREAT DESIGN LAYOUT THAT BLENDS WITH MY WEBSITE The Page will also need to have next steps in regards to sign up (email confirmation send out, redirect to my ecommerce website homepage etc), Terms and Conditions and stuff like that. Frankly I don't know what needs to be in it and I expect that you would :) The design needs to blend with my existing website and on the back end needs to be hosted with my Godaddy account + integrated with email auto responder etc like mail chimp or icontact. If you can create the 1 page SEO content too including linking to my website or write content that makes potential customers sign up, that would be great. I need this done ASAP. Thanks. I PREFERABLY NEED SOMEONE WHO CAN DONE THIS BEFORE AS I CANNOT HELP YOU PLAN THE PAGE DESIGN. I EXPECT YOU WILL KNOW WHAT WILL MAKE A CUSTOMER SIGN UP FOR THIS PROMOTION AND WHAT DOESNT AND HOW WHAT SHOULD BE PLACED IN THE PAGE INCLUDING CONTENT. I know this is not phenomenal work. But I would possibly re-use this resource almost every quarter if not every month to keep running campaigns and potentially other marketing efforts etc. Thanks.