Website Form Creation with Coding (ml)

I need to re-create the form on the front page of [login to view URL] using my account at http://jotform.com. It needs to fit neatly into the area currently used. (top right hanger) I need to collect these fields: First Name Last Name Title Company Phone Email Website Referral (dropdown menu: referral, craigslist, yellow pages, search engine, other) BUT HERE IS THE TRICK.... I NEED THIS FORM TO USE THE S2 HIGHRISE PROCESSOR... [login to view URL]