Convert a Template to a Website

Please find attached the project description in the Instructions.PDF. I would like this to be completed today. Its a very quick job and could take maybe 20 minutes to complete. As shown attached, I simply need a small form on a website to ask for a users name and email address. Then when the user clicks on the "Purchase Tickets" button, their name and email gets emailed to me and they are taken to my paypal payment page. I will provide you with code for my paypal "buy now" button. Please note : this form must be of the same size as the form shown in this website (screenshot shown in page 2 of the [login to view URL]). You will also be required to install this code on my godaddy server on a brand new page. Please note, I want this form to look like the same as the form in the attached Instructions PDF. Very important; to separate you from the spammers, please write “Leopard” as the first line of your bid. We will delete all bids that do not start with this word, since most bidders never read the requirements. By accepting this job, you agree to full privacy, non-disclosure and relinquish all intellectual property relating to this project.