Write some Software

Hello everyone... I am looking for someone to write some code (PHP, JavaScript, etc) for me that I could perhaps include in the header (or is footer better?) of just about any PHP-based web site. The purpose of the code is simple... If you scroll to the bottom of this page here, you can see it in action: [login to view URL] What I am looking for is something identical in appearance/behaviour to the bar at the bottom that says "Need more info? We'll call you (shortly)!" I will customize it later, so please write clean code/CSS so that I can.. but for now, you can use the same colours/images/etc. Please make it responsive. Also, once the form is submitted (and the form data is verified), please have it send an email, and then replace the form with a "thank you" message. Then, after 5 seconds, hide the entire bar. If needed, the responsive version can hide the image of the person. Also, be sure to include the "X" which will hide the bar for 7 days. Any questions, please let me know. I look forward to your bid. Thanks for your time, Keith