Design a stunning and functional landing page for an animal related service.

PetInsuranceQuick.com

Our website connect people with pets (mostly cats and dogs) with companies that can provide them with health insurance for their animals.

Looking for something clean and professional. Not too busy as I want the user to be focused on the lead generation form.

1)There should be a short lead form on the left hand side of the page that is visible above the fold in it's entirety. The first page of the form will ask the following information about the person's pet

- Name: (text field)
- What species (cat or dog dropdown)
- Mixed or Pure Breed(dropdown with Mixed/Pure options)
- Breed or description of mix (text field)
- Age (dropdown with year options)
- Sex (Male or Female dropdown)

2)There should be a navigation bar that has 5 navigation options.

3)Sections for some content and copy on the landing page. I am not set on any particular location, I give you the flexibility to work it into your design. I would only ask for the following guidelines to be followed

If it will be large content areas keep that below the form. Put some placeholder text above the fold and around the form so we can add in calls to action and some short copy. I want to keep long copy sections away from the form so as to not disctract.

4) The footer should just have privacy policy and advertise with us links.