Create a very simple webpage from a mockup

Hi All, I need someone to create the code to get the webpage from the attached mockup. The notes are not to be in the HTML, it's just for your info. The basic code of the form is attached also. The socialmedia code is <!-- AddThis Button BEGIN --> <div class="addthis_toolbox addthis_default_style "> <a class="addthis_button_preferred_1"></a> <a class="addthis_button_preferred_2"></a> <a class="addthis_button_preferred_3"></a> <a class="addthis_button_preferred_4"></a> <a class="addthis_button_compact"></a> <a class="addthis_counter addthis_bubble_style"></a> </div> <script type="text/javascript" src="http://s7.addthis.com/js/250/addthis_widget.js#pubid=ra-4d7a0a2918f5ca30"></script> <!-- AddThis Button END --> Urgent. Needs to be done today I am in search of someone to be this kind of job often. You need to be really used to work with CSS so you could do this kind of job quickly (and cheap of course ^^ ).