Form-Based Flight Booking Website

The website should have an outstanding design. But at the same time very simple. I don't have any ideas to share - I'll trust your taste & and of course your portfolio is a big part for me to decide if I want you for this job.

Required features:
A simple form which has these fields
* an option button (*) one-way (*) return
* Travel From
* Travel To
* Outbound Date (a calendar should pop-out)
* Return Date (a calendar should pop-out)
* Class - economy / premium economy / business / first
* Contact e-mail

All flight requests would be processed manually. That means, when the form is filled out, the request should appear in the admin panel. When a new request is showing up on admin panel, it should be in green color. When I click on it, it should turn red - that way I would know which I've answered and which not.

Regarding the web page itself - it should be one-page, with no extras.