Simple Insurance Single Webpage Design

This will be a simple page design with 4 elements: Header, right box, and zip code submit box.

Tagline: Cheap California Auto Insurance? (I will change this later...it must be text, and not a picture) Accepted File Formats: Standard Web Formats (.jpg, .gif or .png) I would like a page designed based on the following url:   http://www.insurancecomplete.com/state-auto-insurance-quotes_lp.asp   Here is a page that I put together that basically copies that page:  http://www.hmjohn.com/carinsurance  On that page, there is the black text "Auto Insurance Providers in XXXXXXXX" which will have to be on the final listings page. On the original page there are a few elements:   1. The header with all the text. I want you to make something look different than that, but with the same effect of letting someone know they are going to get insurance. MAKE SURE THE TEXT IS TEXT, and not part of the image. I will change the text after you submit it to me (for testing purposes). The point of the header is to draw the person's attention to the listings below.   2. The box that says "Free quotes No committment". I will want something like this on the page too. Again, please make it text, not graphic.   3. The listings in the middle of the page. You don't need to design this, as this part is already done and will be automatically placed in the page just as it is on that page. Instead of the listings, I would like you to design a graphic for the person to enter their zip code. On this page you can see an example: http://www.1carinsurance.org Or you can search google for "car insurance" and look at some of the paid search results for their zip code submit pages.   This page will be used for 2 things.   1. If I can determine the person's state, the listings will be displayed. 2. If I can't determine the person's state, I will display the zip code submit box.   Thus, the pieces need to be interchangeable so that I can display either the zip code submit box, or the insurance listings.   Please contact me at jjonas at gmail dawt com if you have any questions.  

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