Graphic for form entry box needed

I am wanting a graphic of some text with a box around it that will be used for a form on my website. For an example of what I am wanting visit [login to view URL] The large yellow box that allows people to submit their email/name is what I am referring to. I want the box to be similar to that of above, but obviously somewhat different. Currently, I am thinking of a nice blue background with crisp white letters. The text for the box will be "This revealing ebook shows you how. Plus, discover which Online Casinos offer the best payouts. Grab your FREE copy now" Obviously, the graphic will be broken up so that I can add the necessary form fields and submit buttons to it just as the above example has done. In my version of this, I am using an email address field and a submit button. You can see the current text version at [login to view URL] I will ultimately be replacing this text version with what is created here. I will, of course upon acceptance need the psd files so that I can make any future alterations to colors that I may want to test. So the final psd file should be set up in a way that it makes color changes easy. The finished result (form fields and all) will need to fit in to a table 160x in height by 550px wide with a bit of room on each side (5-10px). The current background is an off-white, but I may be using this on other backgrounds as well so the final product cannot be limited to being on a white background. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows (depending on the nature of the deliverables): a) For web sites or other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform The final version must be viewable properly in all current browsers.