HTML Contact box How To Create Html Feedback Form

I want the comment box from my hosted website at maiercs.Com to go on another website I am building. The problem is the code for where the information is sent goes through the hosted client before getting to my email so I cant just strait copy paste the code.

Can someone edit the code for me so I can use the format and get it sent directly to my email? I can send the HTML code to you for editing.

Although I am willing to copy and paste the code of one with equal or greater professional looks if you already have the script for one.