Create an email opt in landing page

I need a landing page based on the content of these samples: [login to view URL] [login to view URL] I would like a modern clean design like: [login to view URL] Landing page requirements: 1) I need the page to comply with Google AdWords and Facebook ads policy. 2) The objective of the landing is to get the user email. 3) To the people who opt in I’ll be giving away a free report, so state this giveaway as a hook to give the email in exchange, (I still do not have the report name, leave the space so I can replace it). 4) Follow as close as possible these guidelines: [login to view URL] 5) I would like some blue or green colors, but I’m open to suggestions. 6) Do not mention the product name directly, just the facts 7) Do not mention the price 8) Do not mention in any form I’m trying to sell something, the objective of the landing is to get the user email not to sell anything.