Create a "Request a call back" button + form processing

We need a small module that can be inserted into any html page as follows to allow customers to "Request a call back": 1. A larger looking button will say "Request a call back" (text editable in code), in the style of our simple website [login to view URL]), (responsive design). 2. When a person would click the button, they will be offered in a fading-in dialog to enter their phone number, name, email and any short message. (name and phone number are mandatory) 3. When submitting, it is important that this form will not be easily used by robots, so a simple capture/honeypot verification is needed to avoid abuse. We can discuss the best simple solution. 4. Once the form is successfully submitted, the person will receive a fading green bootstrap message, "Your request has been submitted, you will receive a call back shortly. (text editable in code). The submitted data will be sent by email (confirm later) Conditions: - For testing, the code can be implemented on a developer site, until we are satisfied with the functionality. - Any text (because of language variations) must be coded, not part of any image. - Some instructions in English should be provided on how to implement it. - There can be no references to external sites for hidden code etc.. so we can be sure the solution has no external dependencies. - After successful testing, the 75% milestone will be completed and funds released. - After delivery of the files and complete code, the final 25% milestone will be released.