How to design Opt in form to generate leads ?

gameofbuzz

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I want to design an opt-in form for my blog and I don't know how to do it.
Please see the following image, this is exactly what I need.

5.png
 
Contact-form 7 + mailchimp plugins, or any PopUp plugin.
 
Most email software should have a optin form designer. What have you checked so far?

Mid November we are scheduled to be releasing ours which you will never need to pay for your list size. The signup form will still be in beta mode but if interested to try it out we'd love feedback and be able to help with design then.
 
constantcontact.com would be helpful for the sales funnel after your prospect has signed up.
 
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