Thanks for sharing it! If you have any ideas for how to make it seem less sketchy while still conveying that we're going to send a free request for you, let me know!
Needless to say, it's a little unfair of me to so casually and easily remark "the page out of context seems faintly scam-like" without pinpointing exactly why, and offering "ideas for how to make it seem less sketchy". This kind of thing is also very subjective, anyway! However, in my opinion, it might be an improvement to drop the caps on "FREE" and perhaps the exclamation marks on the two quoted sentences too. The comment around here by "stfu" about the buttons is also interesting, and hadn't even occurred to me, but seems like a good observation.
Well, the big question for me was, “Why would anyone expect either of these options ever actually work?” and your site does not seem to address this fundamental question.
There are a few little things, too, like the ASCII arrow "bullets" and cheap-feeling graphics, that just make it seem less trustworthy. Contact me if you’d like me to donate a wee bit of time to upgrade your look & feel.