Help! Create Homepage Design for a 2.0 Lead Gen Site

FlexPaydayLoans

Online site that accepts lead applications which will be passed on to various lenders in the cash advance space.

currently not active

https://www.60minutepayday.com/
https://www.paydayloanup.com/
http://checkngoloan.com/
http://www.esurance.com/
(not a payday site, but like the simplicity of the form and layout)
http://www.mortgage.org/
(Another non-cash advance site, but lead gen site in the loan industry, clean and simple with great capture form)

HOMEPAGE

Main purpose is to get them to take action and fill out the
"pre-form" that will direct them to the main application page.

Need a page design that includes the following:

FORM:
When user lands the eye flow should be directed to fill out the lead form ...

Lead form box needs to include
- Amount $100 - $1500 drop-down in increments of 100
- First Name
- Last Name
- Email
- Zip Code
- Nice red/green/orange submit button

LAYOUT:
- clean, user-friendly interface
- prefer to have white space with a white background
- professional layout design that communicates trust
- image of woman/couple can be used
- simple 1-2-3 steps can be used

WORDING:
- instant approval
- wired in 1 hour
- bad credit OK
- Simple, Safe & Secure

Place for small blurb on what we do, as well as
4 small sub-sections with articles ...
disclaimer in the footer

INTERNAL LINKS:
- How it works
- FAQ
- Rates & Terms
- Contact

COLORS:
1-2 more colors that complement the logo.
Logo colors are : 9c1a24 & 226df1

Demo is mainly females age 25 - 45 ...
Any images should be females in that range, or couple