Wordpress Plugin Development

Hi there, I need a Wordpress plugin developed. It would be a modal pop up. However, not a complicated analytics thing behind it. I will however expand on functionality, once I start getting money. Eventually, it will be like a freemium plugin. Front-end On the front-end, site visitors will see a pop up modal (See attached) that asks for them to sign up to the sites email newsletter, asking for a name and email address. Back-End Once the visitor signed up, the Admin will be able to see, edit, delete and export to .csv a list of sign ups. If you look at attached, the Admin will also be able to select which fields they want to show or Add new text fields, also be able to upload the image to the left (Maybe with a google recaptcha) too. It must be of high standard, enough to submit to wordpress plugin directory though. Thank you Anton