Video Opt-in Page template and util needed - URGENT

This project is to provide a template for me to place the code for my YouTube video in, Google analytics script, header, banner, etc.? AN easy set up of a video landing page for people to opt-in to and provide email details.? I require that a script or page using textboxes and a submit button that will produce this file and place it on my desktop or specified ftp dir on the web. ## Deliverables [login to view URL] requirements notice: As originally posted, this bid request does not have complete details. Should a dispute arise and this project go into arbitration "as is", the contract's vagueness might cause it to be interpreted against you, even though you were acting in good-faith. So for your protection, if you are interested in this project, please work-out and document the requirements onsite. The template builder should provide the following: (Used within a web based environment and browser) The template builder will take the following info: 1. You Tube embed code 2. Banner for title to page (choice to not use it) 3. Video on left (not image as example website) 4. The right animated arrows in middle but using red 5. The aweber script code for the opt-in box on the right 6. A title to the page that appears above these (on example website it starts as "How you can rapidly..." (I need to be able to indicate where letters should be bold and red but black as default - font to be specified) 7. Ignore the text "Tired of blogging..." The text place is not needed in the template. 8. Colour for the background of the page 9. Place google analytics code 10. Place split tester code in 11. Footer image if necessary 12. Should include link for disclaimer and privacy policy on the page below the awebber opt-in box.