Landing page CAPTURE members

I'm looking for a pre launch member capture landing page The landing page needs to be clean basic and simple and have the following features - about us : information relating to what we are launching a count down timer coming soon - data capture point (input name and email and postcode) (back end this information will be stored to enable us to build a member database pre launch) capture password for client use to log in to final website when all data ported over - space for short video to play - business owners contact us today to find out how we can help your business smash your targets (information form when button clicked allowing businesses to contact us)