landing page

I need 3 landing pages created, they all will have the same template and basic design with minor changes. When user visits the landing page, they must enter their email address to be taken to the affiliate link. I want the user's email address entered on the landing page to automatically appear on the affiliate sales page. NOTE* (I do not own the sales page, but I understand this still can be done with a script). In addition to web development skills, Preference will be given to people with design experience, photoshop etc See the image file for an example of how I want it to look.