Create a poll / survey so I can send it to clients via e-mail

Hey there! The job is pretty simple. I need you to design a functional poll/survey that I can send to clients who are interested in my product. It should be something similar to what you would find at surveymonkey or other poll websites, but I want it to be custom for MY product, and so that when I send it to people, it looks professional, and allows them to insert their specifications for what they want in their demo (the service I provide). All information will be provided to you, and I also will guide you for a simple color scheme. I know that this is a somewhat unconventional project / task, BUT, I would certainly appreciate it if you provided samples of similar work in the past, or at least 2 samples of your previous design work so that I can trust your skills. When responding to this job post, please provide the following information: 1) Your favorite color 2) Any questions you have regarding the project Thank you very much for expressing interest! I look forward to a great partnership. Sincerely, George K. P.S. There is more work in store in the future for the person who gets this job and provides me what I need!