As I understand it, you need an e-mail sent to the person who fills in the form. That e-mail should contain the person's name (and possibly his phone no.) and you probably want a record kept in a database contaiLagi
I have understand your requirements very well.
This is a very simple for me.
Having more than 5 years of experience in web development in PHP/MYSQL/DRUPAL/JOOMLA/HTML/CSS/AJAX/JAVA, I think it is possLagi