Email gathering / twitter tool for my sales page

Hello, I am looking to have a tool designed for my sales page on my website. This is for a promotional idea. Here is what I am looking to do: I am giving away a free product. For people to get a chance to win this free product I want them to do the following. 1. Visit my homepage. 2. Fill in their name and email address. 3. Click a "Tweet" this icon - When they click this it will open up their twitter account and tweet my pre-written message. 4. Follow my Twitter account. We can use the code from my Aweber account to gather the name and email address....but I want this twitter feature all designed into the same form. I have seen quite of few other websites use a "Tweet" my message type box... So I am sure this software is out on the web for free somewhere. As far as requiring them to follow me back..I think we can just require that in the rules...and don't need to automate this with the software... Looking to have this done in a few days time...Hopefully for this weekend? Thanks! Pleas let me know if you have any questions! Mike Roberts