I need a site that will allow potential customers to submit their email in order to receive free samples/cupoun codes to purchase our products on our retailers' web sites.
When someone submits their information, it will make a post on their Facebook wall announcing that they are trying out this product, and will have corresponding info that will be included with the facebook post.
Users will also need to verify the email they are submitting and we must have a way to verify the Facebook post is not immediately deleted in order for their submission to be processed.
Work will also include light graphical work (headers, banners, some integrated graphics) and we will need a comprehensive backend of the site that allows us to track and manage all of the information.
In all, the site only needs to be 4-5 pages total.
I am able to give specific examples of sites that we would like to mimic once we are in discussion.