Need a PayDay Loan Microsite with Thank You Page Template - repost

Hi, One Theme I would like to see if a page that has a clean look and feel as a cash machine. Two Columns of DataInput and a Submit button on the bottom. Needs to have a place for the company logo - url on top and on the base of the 'cash machine' a clean place to put info and disclaimer text. This needs to be done in html tables, I do not want div powered by css. I'm going to be using this in a master page template and sometime heavy div css driven template do not play well with the .net user control and master pages. This is a small project $50 maximum based on relevent previous design.. Those who can provide a quick mockup of the cash machine template will take first place in line. Attached is the form field specification, it is case sensative please include all relevent spec information.. I would also need a Template for the thank you page after they submit. Similar site are listed below for inspiration -------------------------------------------------------- Something with a look and feel similar to, but doesn't need menus just the form and a place to put some quick info and disclaimer text. Example: [login to view URL] [login to view URL] [login to view URL] [login to view URL] happy bidding.