Need a wordpress template designed

I need a WP template designed to look like this (http://www.melanieduncan.com/category/blog/)

All I need is the 'shell' I will populate everything, add pics etc.

Must include the following:

Header- slim
Left: Logo
Right: Pages/menu

Banner-
Picture (editable/different pic for each page)
Horizontal sign up form (fixed) (already got one)

Right side bar (on every page)

Footer

Pic/video & newsletter sign up form-
Bottom menu bar (editable)

I look forward to hearing from you.

Completion date: 27 August