create join page ---> set up with aweber + clickbank

Hi All, I need a coder to create a simple 2 step join form that integrates the site + aweber + clickbank 1. step one Join page where a users needs to enter: Full Name: Organizations Name: Email Address: Plan: (2 check boxes) Under this I need details displayed on the page that relate to the plan that is selected by the user (similar to this new vworker project set up box) under this is an option to add an extra product via clicking on the title Order button User clicks the order button 2. Details automatically sent to aweber and they are signed up to a mailing list 3. The details that were entered are ported to clickbank (ie name etc) - additional product as select on the join page is added to the order if selected This must be fully tested and working on every major browser i can send over a sample join page (that has most of the functions required) once you let me know you can do this Sites hosted on rack space cloud sites platform so you have to create something that works with this platform Any questions let me know To ensure you have read this message in full please start your reply with my first name as detailed below (If you do not your message will not be replied to) Thanks James