This is a basic outline of what I want: http://i.imgur.com/zNNCPSd.png
Like I said, its basic. I will want it to be laid out perfectly, aligned perfectly, and look clean+modern+professional. Also where it says 'NAME HERE' it would be awesome if it could display that persons forum username+their avatar, and you can click on it to go to their forum profile.
Paying for this obviously. PM me if you can do this.