Front End Development for Graphic Form for Website

Closed - This job posting has been filled and work has been completed.
Fixed Price
Deliver by - December 20, 2013
35
Budget

Details

I'm looking for a develop with advanced experience in HTML/CSS and basic javascript.
I'd like to have the following done:
1.  Take the sliced graphics and create a header input form as seen in the yellow attachment.  Create the HMTL/CSS for it for the header.
2.  Create cursor prompt javascript code for the header
3.  Take the sliced graphics and create a footer input form as seen in the blueattachment.  Create the HMTL/CSS for it for the footer.

What I've attached shows the graphics to be used, below them will be different input fields which will be provided later.