Coupon needed for front page of website

We have a website where on the front page we need a flashing link which when clicked will open a new window which contains a coupon. The coupon is only to contain a heading of three words and regular text of 46 words and followed by a form which has first name, last name, City address, phone number and date of travel. When the customer clicks submit then the coupon prints and the form contents are sent to an email address. This is a rush job