Easy PHP Development!

Dear PHP Developers,

I am working on a few basic forms, and I want someone who can write a PHP script which will e-mail the form to me and the person who fills it out with the e-mail address they put on the form.

Basic Page is at URL

I will be adding a couple more fields, but that is all you need to do! Let me know what you would charge to do something like this!

Thanks,
Lance R.
URL