Setup landing page for our future website (Coming Soon, type page)

We will be launching our site in February/March of 2019. However, we would already like to have a very basic landing page on the domain. Currently, there's just the standard domain registrar parked page there. 1. I'll provide you with a basic graphic we'd like in the background- you will need to set it up on a server (I'll buy hosting somewhere for this). Of course, it'll need to be responsive- even though it's just one page. 2. We will need one component added by you: "If you'd like us to contact you just prior to launch, leave us your email address." Beneath that, an email address & name submission box, and of course- a database that'll collect these email addresses & names. 3. The attached graphic is basically what I'd like to show on our landing page- with an improvement or two- just to make it look a little better. I want to show a preview of our sign in page, but blurred- so as not to give away too much at this point. Just some text above it all, hinting at when we'll go live, for example- in the center: "Q1, 2019" This is probably a 1-2 hr task at most for an expert, so I am counting on bids that reflect the simplicity of this task. Thank you, PJ