Build Basic Website

Alright now what i need is to have a website designed and uploaded to my blogger blog or similar or to domain and hosting this can be discussed later on But what i want is a page set up so i can have people come to my page looking for information on product and have to enter email and name to receive it I will supply get response code and any thing else needed but this will have to be set up and functioning website or blog when your done Thanks Best Reguards ? Ben Powell