Squeeze page and CRM set-up

General information for the website: Squeeze page with video
Kind of development: New website from scratch
Num. of web pages/modules: 1 page
Description of requirements/features: I need a detailed-orientated and quality-focused individual to create a squeeze page with integration with mailchimp and capsule CRM in the backend.
The squeeze page must work on mobile applications and computers.
The sign-up box must ask for:
• First name
• Surname
• Email address
• A choice of either “I am a lawyer” or “I am a business owner”
Data received through the sign-up process needs to link into Mailchimp and Capsule CRM accounts to enable clean capture of data. This must be tested.
We don’t yet have the wording for the website or sign-up page, but it is on its way. We will need instructions on how to incorporate text later on.
We will need full instructions and log-on for getting into the back-end easily to make changes (through wordpress, I assume!).
Extra services needed: 3rd party integration
Specific technologies required: Mailchimp, Capsule CRM (already have log-ins for these
Extra notes: I have the branding, logos, colours and a design of the squeeze page in a PDF format - attached.

I have the video for the middle of the site (on a Wistia account). I have the domain and log-ins to 1and1, mailchimp account, capsule CRM and a wordpress account, but you will need to tell me if more is required!