Build a Website -- 2

I need a Landing/Lead Capture Page created. I have the page designed, I just need someone to bring the page to life. There are a few functional elements which I need that might make this slightly more than a "simple Landing Page." 1-I have 2 spots at the top of the page (above navigation) that I need full editing access to. These fields only contain a simple dollar figure. 2-On the 3rd panel, there will be an image carousel. These images will contain a logo and 3-4 lines of text. There will be 3-4 of these images that display in the carousel at a time. 3-I need to have a "Register Now" field that will contain First Name, Last Name, Email, City and State. My (already Live) site is a site that offers Merchants a more functional way to market their business to the community. We already have Merchants and subscribers in our immediate area. We are in the process of expanding into other major market areas across the US (Chicago, St. Louis, Vegas, Boston, etc.) and want to use this Landing Page to pre-market in those areas. Because of this, we will be using subdomains for these areas (ex. [login to view URL]). This Landing Page will be connected to these subdomains. I'm thinking I will be using MailChimp for capture and auto responder purposes. However, I am open to other suggestions for this as well. I will be happy to discuss in further detail and supply images/layouts to those that might be interested. Thanks!