How do i add a lead capture form with an ebook image

I want to ad image at the top of a lead capture form to entice visitors to download the eBook on offer.

I understand their are various lead capture form plugins around that will allow me to capture lead data prior to a visitor downloading my ebook.

However I want to add an image of the ebook on offer at the top or side of the form. I’d be happy if this were an additional plugin.

NOTE: I don’t want to create a seperate landing page for the ebook download. I know i can do this, and will do for other offers but i want this on my home page.

Additional:
One the form is complete I would like a secure yet EASY way (not capture) of delivering the ebook i.e. through a direct link sent to the recipients email after completion. I’m open to other ways of doing this.

I want this to go on my home page of a site that will most likely be developed on a theme i purchase through themeforest etc.

After completion I either need an email or ideally the lead information to be captured in my CRM or constant contact.

Thanks, I’d appreciate any help.