Magento Mailchimp sign up page

Overview: We need a Magento CMS page which gives a free gift for newsletter signups. Detail: This page needs to fit in as a block to the current template like a CMS page, all AJAX driven, no reload. It needs to take customer details with input fields including first name, last name, addr1, addr2, suburb/town/city, postcode, state. After submitting the form the module will check our MailChimp account via API to Mailchimp to check if the email address is already subscribed. If the email address is not subscribed the module will generate a guest order as paid (ie, generate in invoice as well, $0 value) and show the 'Success' message. If the Mailchimp subscribe fails or generating the guest invoice fails the module will show the 'Error' message. Additional: On page load, if the customer is logged-in the module will check MailChimp API for subscription status. > If the logged-in customer IS already subscribed the form will auto-fill with the available details and all input fields will be DISABLED, submit button will be DISABLED, and the 'alternative' message will be displayed. > If the logged-in customer IS NOT already subscribed the form will auto-fill with the available details. The messages can display at the top like Magento alerts or like JQuey alerts, ie in DIVs, not javascript 'alert' pop-up The admin panel should include: Text Input for Mailchimp API key Text Input for MailChimp List-ID field Text Input for a Magento Catalog ID code (the item to be put on the order / invoice) 3 x TextArea inputs for messages: Error, Success, alternative message. YES/NO checkbox for enable/disable of the free gift. Notes: To simplify the task assume the Catalog product will never be an item with product options. The item will always be $0 when generating the invoice, the qty will always be 1, the invoice will always be 'paid' as if it was a free item. The 'enable/disable of the free gift' setting in the admin will be used by us in the PHTML, it needs to be included in admin but can be ignored. The page does not need to show up as a CMS page in Magento CMS->Pages list. All html can be set in a phtml file which we will edit manually for final layout, the module only needs to be complete in function not layout design. We will edit HTML layout and CSS ourselves, we would only expect unique IDs in the HTML for use in AJAX etc.