Add a customer email sign up form

I need someone to quickly go into my site and add a customer email form. [login to view URL] It will simply be a two line form where customers will enter their name (not required) and their email address. It should be present near the top of the page, right under the green line that currently says welcome! Then underneath it you see a area with that text written again. You will erase that and write the next text we provide and the form. this form will then process and send to our email address. This is so simple, its just unbelievably easy. You need to get this done in 1 hour. LOW bids win. $10 dollars max for this FAST JOB!