Adjust the code for the site

Employer
[no-member:pro]Dmitry[/no-member:pro]Dmitry
Project parameters
Type of cooperationOne-time project
SectionWeb development
Prepaymentwithout prepayment
Payment methodsElectronic money
Acceptance of requestsclosed
Project description
For the site: is required on the main page of the site,
To adjust the code that I will form on to form an application, so that in fact everything remains as it is (visually), only by clicking on the button "Get the results of the check", the customer got into the subscription list , and the application came to my address with the parameters that the client chose.
The reason for the request is that the application form for provides only 2 fields - name and email, this is not enough, and the design must also be adjusted for the site!
To adjust the code that I will form on to form an application, so that in fact everything remains as it is (visually), only by clicking on the button "Get the results of the check", the customer got into the subscription list , and the application came to my address with the parameters that the client chose.
The reason for the request is that the application form for provides only 2 fields - name and email, this is not enough, and the design must also be adjusted for the site!