PROJECT RE-LISTED - BAD CHOICE MADE EARLIER

First: I need someone to help me set up a form on my site. If you visit this temporary link: http://www.mob45.com/temp/temp-page-for-form.html
You will see the one form we have and notice all the fields we need filled out. Not all of these fields are required but they are required to have to click on the check box that says they read our terms and conditions. This info will be emailed to 2 email accounts and will be supplied to the project winner. You will also notice for some reason the form we have currently on this page the left side of the form is showing 2 lines when it should be one line that makes up the boarder. This will need to be fixed for me too please.

Second: Now if you also look down the side of the page near the bottom we have a subscribe to our newsletter box that we also need filled out. This will send a notification to 1 email address (again given to the winner of this project) and also we need a database type thing to help us keep track of these emails we get to subscribe.

This is what I want to do. This form and subscribe form are both on a TEMPORARY page, and I want to be able to simply copy and paste the coding into multiple pages on my website. Also the winner will receive a ZIP or RAR file containing the graphics on this form (boarder and buttons used on the form). When your done working on this I will copy and paste it into our website and test things to work.

I will be able to pay you by either paypal or through scriptlance but only after things are working on our end please. We have had a few bad recent experiences that has ruined things for others. Our feedback on here should show to you that we are honest and will pay you once things are working. Also we would like to have this form done ASAP.

Thanks and looking forward to hearing from anyone who can help with this.

Mike