Need simple opt in page created

Fixed Price
Deliver by - February 16, 2013


I need a simple opt in page created that has an email opt-in form embedded on it like this webpage:

I need the page to have an exit pop that prompts the user to stay when they try to close the page.

In your application, please send a link to an opt-in page that you created so I can see your style of work.

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