Hello there ,my name is Ebrahim Mohammed, I have been a programmer and a web designer for over 5 years now with a lot of experience in HTML,PHP,CSS,ASP.NET,C++,C# and many more programming and web designing languages, I have read your description and I understood that you want to create a simple HTML form which will send the values on the email, can you please contact me ? I will be glad to do that today for 15$