Web-to-lead registration box (CSS/Functionality)

Hello, I have attached a picture. I have a form already done. This form currently uses input boxes in a form structure to get names and emails. I would like this to look much more appealing by using this image attached. They will type in their first, lastname and email. All i'm wanting to do is use this form instead of your basic webform. Please ask questions to make sure this project makes sense BEFORE placing a bid. Current form: [login to view URL] New form image: [login to view URL] Added functionality: It needs to use java to check to make sure all the fields are filled in. Email also has to be in the correct format. If not, an error message (java box) will appear.