Quote Box on Wordpress Website

Hi guys. I'm in the process of making a website and I want to have a floating widget on the right hand side that is a quote box that the prospect enters in their zip code and it takes them to a contact form page. I just want to have them be able to leave their name, phone, email, age, and zip code. I have seen these before on other sites. I am using wordpress and I'm wondering if any of you know of a plug in that will work for this. If not, do you know anyone who can create one of these boxes for me? Any help is greatly appreciated! Thanks
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