What kind? PHP?
Edit: Hre is a PHP one.
HTML stuff:
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Email Form </title>
</head>
<body>
<form method="post" action="sendeail.php">
<!-- DO NOT change ANY of the php sections -->
<?php
$ipi = getenv("REMOTE_ADDR");
$httprefi = getenv ("HTTP_REFERER");
$httpagenti = getenv ("HTTP_USER_AGENT");
?>
<input type="hidden" name="ip" value="<?php echo $ipi ?>" />
<input type="hidden" name="httpref" value="<?php echo $httprefi ?>" />
<input type="hidden" name="httpagent" value="<?php echo $httpagenti ?>" />
Your Name: <br />
<input type="text" name="visitor" size="35" />
<br />
Your Email:<br />
<input type="text" name="visitormail" size="35" />
<br /> <br />
<br />
Attention:<br />
<select name="attn" size="1">
<option value=" Sales n Billing ">Sales n Billing </option>
<option value=" General Support ">General Support </option>
<option value=" Technical Support ">Technical Support </option>
<option value=" Webmaster ">Webmaster </option>
</select>
<br /><br />
Mail Message:
<br />
<textarea name="notes" rows="4" cols="40"></textarea>
<br />
<input type="submit" value="Send Mail" />
<br />
Free Code at: <a href="http://www.ibdhost.com/contact/">ibdhost.com/contact/</a>
</form>
</body>
PHP Stuff (save this as contact.php):
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Sendemail Script</title>
</head>
<body>
<!-- Reminder: Add the link for the 'next page' (at the bottom) -->
<!-- Reminder: Change 'YourEmail' to Your real email -->
<?php
if(!$visitormail == "" && (!strstr($visitormail,"@") || !strstr($visitormail,".")))
{
echo "<h2>Use Back - Enter valid e-mail</h2>\n";
$badinput = "<h2>Feedback was NOT submitted</h2>\n";
echo $badinput;
}
if(empty($visitor) || empty($visitormail) || empty($notes )) {
echo "<h2>Use Back - fill in all fields</h2>\n";
}
$todayis = date("l, F j, Y, g:i a") ;
$attn = $attn ;
$subject = $attn;
$notes = stripcslashes($notes);
$message = " $todayis [EST] \n
Attention: $attn \n
Message: $notes \n
From: $visitor ($visitormail)\n
Additional Info : IP = $ip \n
Browser Info: $httpagent \n
Referral : $httpref \n
";
$from = "From: $visitormail\r\n";
mail("YourEmail", $subject, $message, $from);
?>
<p align="center">
Date: <?php echo $todayis ?>
<br />
Thank You : <?php echo $visitor ?> ( <?php echo $visitormail ?> )
<br />
Attention: <?php echo $attn ?>
<br />
Message:<br />
<?php $notesout = str_replace("\r", "<br/>", $notes);
echo $notesout; ?>
<br />
<?php echo $ip ?>
<br /><br />
<a href="contact.php"> Next Page </a>
</p>
</body>
</html>
Edit accordingly.
Hope this helped!