Design HTML Template for Feedback form

The job is to design a html template for a feedback form. The feedback form is a webpage that is shown after the software is uninstalled. The feedbackfrom contains a some input/text fields to get infromation from the user. BUT, it also will contain a offer to purchase the Software with TrialPay. You have to review some website that offer TrialPay, too. We want to have the trialpay offer on the left hand side of the page. Please connect to the website that is currently damaged in case of a relaunch: <[login to view URL]> There you see the main form. TrialPay have to be a a teaser, means something that will offer the user something and the user have to see, so it have to be colorfull but also shows the sense of TrialPay. Be creative! Pages: 1 HTML Page