Create a simple PHP/HTML Web 2.0 Template

I need a template with the look and feel of something like [login to view URL] and [login to view URL] It must be a 1 page land page without any menu items. Underneath the main image I would like there to be space for list 4-5 things in a bullet list. At the top of the template file I want to have config options. These will just be PHP variables. The following must be set using PHP variables 1. URL to main image 2. Title of Page 3. Niche of page (i.e. Funeral Cover) 4. URL to logo image (i.e. Hollard) 5. Array of 4-5 strings to be used in bullet list 6. Background color of page (i.e. purple) 7. Color for "Call me back..." and SUBMIT button Make use of [login to view URL] to validate form. Make sure all fields are filled in and that email address is in a valid format.