Simple Capture Page Layout

I am looking for someone that is good with layout and understands good direct response copy. I want a very simple capture page set up and then I would like 3-4 variations on the original so I can split test it. Here is and example of what a page should look like. [login to view URL] As you can see it is just a simple page. That focuses on the text not flash animation. That is similar to what I want just simple yet well laid out. I have included some photos that can be used and I have included that html for the form as well as the java script for the form. I have also added a form. Let me know if you have any questions. I want it so I can down load it into NVU and change everything myself. I shouldn't see this costing any more that $50 and possible less. I have added a video skin as one of the layouts will need to include this video skin. Here is the form text from Aweber The site should be 750 pixels wide Java Script <script type="text/javascript" src="http://forms.aweber.com/form/00/1078357200.js"></script> HTML Code <center><form method="post" action="http://www.aweber.com/scripts/addlead.pl" target="_new"> <input type="hidden" name="meta_web_form_id" value="1078357200"> <input type="hidden" name="meta_split_id" value=""> <input type="hidden" name="unit" value="wecanretire"> <input type="hidden" name="redirect" value="http://gazutz.edcgold.com/cp/thankyou.php"> <input type="hidden" name="meta_redirect_onlist" value=""> <input type="hidden" name="meta_adtracking" value=""> <input type="hidden" name="meta_message" value="1"> <input type="hidden" name="meta_required" value="from"> <input type="hidden" name="meta_forward_vars" value="0"> <table> <tr><td colspan=2><center><div><font face="Geneva" color="#ff0000">         Show Me Now !</font></div></center></td></tr> <tr><td>Email:</td><td><input type="text" name="from" value="" size="20"></td></tr> <tr><td>Name:</td><td><input type="text" name="name" value="" size="20"></td></tr> <tr><td align="center" colspan="2"><input type="submit" name="submit" value="Submit"></td></tr> </table> </form></center> I will upload other pictures to send [login to view URL] so I will need your email address so you can down load them.