Customizable Form

Can anyone recommend a simple form that can keep a list of names? I’m behind in launching the most basic page and can’t get anything to work. The MailChimp bric doesn’t seem to work and I tried using Wufoo and can’t seem to customize anything even with adding a class. Any help would be great. Attached is the pic and example form I’m trying to use. Should be simple but has taken hours to customize and actually get it to work. I also attached the examples of what I get while trying to use the MailChimp bric.