Pop Up Design - Email Capcha

Design details: I have this page http://www.classquickdownloads.com/recruiters/pages/sd/brand/1/brand.html but I need the pop up changed.

I want a pop up like this one http://funnelblueprint.com/ultimate-funnel-blueprint/?utm_source=house-list&utm_medium=email&utm_campaign=fb-mc-3-16-15

The code to make the pop up I can do. So basically just the design of the pop up.

Instead of 'Yes Ryan I need your funnel blueprint' can it just read 'Yes I need this document now!'

I have attached a text document which generates the code for the email capcha section.

This text 'Please Send The Funnel Map & Video Walk-Through To The Email Address Below' Can remain the same as I can change that at a later date.

I need this done today please.


Thanks


David
Ideas for the visual style: See above
Extra notes: