Create a Wordpress Plugin/Theme For List Optin

I need a wordpress developer to build a plugin for me. If you can't build a plugin then you can build a theme. Here are the requirements : 1) Check the attached image for format 2) The plugin should allow creation of just one page which will have a video on left and a list optin box on right. 3) I prefer plugin as it can be installed on any theme. After installing you just need to allow an option to create a page like : squeeze video. When user selects it, he will enter just url and page name. 4) Plugin should be responsive (should work on mobile, tablets and pcs) There is not much customization - ask user for title image, video. optin box image, optin box color and optin code only. Allow him to change logo, header menu and footer menu. Nothing else. look at this demo : [login to view URL] modify it to cover the whole screen with that blue part. The video player should have bigger size and optin box should be bigger in size (width will be same). Just length will be more. If you need the php, PSD or the HTML/CSS file for this theme let me know and i will give it to you. Project cost - Max. $200 ($200-$250). Please post word "squeezeplugin" in your bid. People who can code plugin will be chosen priority wise. Regards,