Can I make a form like this with Highend?

I don’t really see any element in this theme to be able to build a simply form – for collecting, say, a name and email address.

Attached is just one example of what I would like to do. So I can offer my visitor a “Free Report” or an “Infographic”, etc,…

Can this be done with Highend? If so, how? If not, do I need to find some type of “Form Building” plugin? If so, do you have any suggestions?

Thanks.