Registration Form on Splash Page

Hi - I am in the process of designing and creating a buy/sell/bid website. In the meantime, i would like to start asking for suppliers and sellers to register on my site to build up my database. A registration form is required - email address / password details - with the template that I currently have but may require a bit of tweaking - therefore experience in Graphic Design is necessary for this project. I don't see it as a large project, so therefore quick turnaround is required.