landing page creation

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Job Description

Hi
i need to create a landing page that will accessed after clicking on a post / ad on facebook
i need the actual building of the landing page as well as the design of the landing page
functionality:
once user is landed in the landing page, he will be asked to fill in his name, email address, phone number and press submit. once he did it he will receive a code from a pre-defined code list.

all date (name, email, phone number) should be saved into a data base / file for further use.

the intention of the campaign is to sell cellular phones. i will provide the phones images but i need a general design for the landing page