Web based Form design using HTML, CSS, Jquery, Javascript

I require to create a Web Form based (creating one - only 1 - ASP page for that) using HTML, CSS, Javascript, JQuery. It must to be compatible with all browsers (IE, FF, CH, SF). The elements to be designed must to be located properly. You can check them in the files attached (the page to be created has to be similar to the image attached which is a window of a Windows Desktop version). I need a modern style, non invasive, easy to read for the user. Follow some lines (watch them in attached file) and comment me your idea or give an example about the design. You will show me two or three styles, so I will choose one finally. Note this could be a first of many works to this kind. I'm managing this site and my client will needs more modules in the future, so, don't make a high bid. If you do a good job, I'll likely need your services again.