Small Changes to A mobil Webpage and a create Script to gather emails

Ok my page is [[login to view URL]][1] I will make the make much smaller and I NEED A SCRIPT THAt THE PERSON in order to download their trial they will have to fill the information of his name and email address and that will take hin to a page that will say thank your free trial aproval will be sent to you in the next 24 hours to your email address and that will be conenected to my awaber account so I wil email them more information The work should be simple for those who know.