Set up landing page for web & mobile. Integrate billing api

I would like to set up a Landing page for a Mobile Subscription service. I have the artwork and page layout ready. The attached artwork displays the basic layout. Am open for suggestions on how to improve it. Below are the requirements: Features: 1. A widget with a number box where subscribers will input their mobile number to subscribe into the service. 2. To be responsive and work well on the web, as well as across all, or most mobile handsets. 3. Include an Administration back-end where the text and Images on the site can easily be modified. 4. Integrate google analytics on the site. 5. Integrate an api to whe widget, to link to the mobile aggregator. 6. Include a text scroller. The text next to the image will scroll. How the widget works. 1. User inputs their mobile number. If they click the submit button/image before checking the terms box, a Pop up window informs the user to first agree to the terms and conditions. Check the Terms box. 2. When user checks the Terms-box, and then submits. The following message pops up: "You should be receiving a message shortly. Please read that text message and confirm the PIN number" 3. A billable message is sent to his phone, if the user has enough credit on his handset, he is billed and receives an sms with the pin number. 4. He inputs the PIN number and is taken to the Thank you Page. Attached is an Image of the Site. We shall Provide png file with the text plus fonts.