Create an html5 banner with input text fields for Google Adwords Display Banners Using Google WebDesigner Software. -- 2

We need Google WebDesigner Banner Adverts for Google AdWords Display Network. We need just a template of 300 pixels x 250 Pixels with 2 text input field ("name" and "zip code" and a submit button. We need to have the text inserted by the user in the banner as a GET variable in the landing page, for example [login to view URL] We already to that in AdWords with Flash banners, we need to do the same with an html5 banner. The total zipped file size for each banner must be less than 150kb Please ask for further information. The final adverts MUST be HTML5 files created with Google WebDesigner ready to be added to Google AdWords (published in zip file from the GWD software) - We specifically need it in GWD because AdWords only supports HTML5 files created with GWD. Please do not submit a contest entry if you are not able to carry out the task using the GWD software for Adwords.