Landing page cleaning company

I need a landing page for a cleaning company.

The company provides cleaning services to both commercial and domestic customers. The landing page would need to be able to capture the following information:

customer email address
customer contact number
type of service required - this can be from a drop down menu or the customer can type their own service requirement.

I would want there to be a large button and short list of 3 benefits.

I would prefer it if it was clear that the business was based in West Yorkshire and served the whole region.

There would be a contact number and an email address plus 2 client testimonials.

Also image, this would need to be sourced by the winning bidder.

The type of landing pages I like are: https://squareup.com/, http://bondsy.com/beta, http://www.localhero.com/

The domain name being considered is swipecleaning.com.

I would prefer it if the email address could be set up too, i.e. when the customer clicks on the send / contact us button it goes through to an email address that I want it to.

Any questions please let me know.