Contact Us Form

I want to create a Contact Us form for my website. I anticipate some simple javascript (or similar HTML compatible language) that I can copy and paste into my 'official' Contact Us page. I am using a hosted application that allows me to upload and manage page content, etc. I want the following characteristics: 1) Prompt user to enter their email address 2) Prompt user to confirm their email address 3) Prompt user to chose "Subject line" from a dropdown menu (general inquiry, support, etc. I will enter this in the form 'properties' ) 4) Provide a text box for user's message 5) Provide a 'phishing filter' or similar security measure to avoid spam. I would expect the user to enter 6-8 characters that validate a human response. 6) Include a "Submit" and a "Reset" button. 7) The "Reset" button clears the form 8) The "Submit" button sends the email to me. Optional/Preferred - I would like to configure the "submit" button where I have a choice of where the email goes. For example: I may send "support" questions to <support@[login to view URL]> and "Membership" questions to <membership@[login to view URL]>. Additional info: I can provide a mock-up example, which includes the form, dropdown box, text box, submit & reset buttons. It does not include working functionality or phishing filter. ## Deliverables =