Lightbox form

Hello - I am looking for a coder who can design / develop a lightbox popup form exactly the way it's popping up on this site - [login to view URL] 1. No close button 2. The form should stay unless the user/visitor submits the details. 3. Once the form is filled - and user submits it, the form should be closed. 4. Email needs to go to a couple of email addresses with the form details