I need a small email optin html form for my blog (420x315) which contains a graphical element for my offer (which I can provide), a headline, some text and two buttons - "email addr" and "subscribe now". I use icontact for my email list - I can write the code for the form submit.
Look at the optin form with the free ebook giveaway on the right side of this blog as an example. [login to view URL]
I'm looking for a graphics pro who can put something together that looks professional. Please only respond if you have prior experience designing optin forms.