Create a simple responsive newsletter sign up form

I am looking for someone to create a simple sign up form for a website I am launching. It will need to be responsive, and I'd rather it be dead simple. Basically user will visit the site, if it's interesting for them they will leave their email address for us to contact them post launch. I would do this myself, but I have other things I need to do to get the business up and running. Personally I would think this would take max 1 hour for someone who knows what they are doing! I have attached a simple wireframe of what it would need to look like. Few things to note: *If you can include google fonts - Roboto Slab for header and Open Sans for text body that will be great! * Sign up confirmation in line will be required i.e. after they click 'sign up' it should just replace the header text and text body and sign up box with - "Thanks and we'll be in touch when we're ready!" * No logo or images required for this, I already have those! You can use a mockup images if you like! * Background image will need to be static not tiled or anything like that. Feel free to get in touch should you need any further clarification. Walli