Lightbox Hover Signup Form

Hi, I need to create a lightbox style hoverform for my website [login to view URL] The input from the hoverform would be sent to my OfficeAutopilot account. I would also like the recipients to be taken to one of two sites depending on what radio box they click. The form would need to be nearly identical to "[login to view URL]" The hoverform should only appear the first time someone visits my website. The hoverfrom should not negatively impact the way Google views my pages. Turn around time is important for this task. I would need to be informed of where the hoverform scripting is located so that I can make changes down the line when necessary.