application form sender

Alrite i need a simple script that will send certain info in text boxes that a user enters and then sends these as an email to a web server. Information entered will be such as suburb, parcel wieght, and delivery time. greater detail will be provided when required. PS. ok more info, im pretty sure the email server runs smtp but i will have to confirm that with the company owner. like i stated above, this script will be put into a html file, where clients can enter certain variables. Some variables will be manual such as parcel wieght, and when they require a certain parcel delivered by, but also possibly a drop down menu style selection for suburb, which will automatically determine the postcode. Now i can get the list of suburbs that the company services, there are alot, so i dont know if its too efficient if its to be all stored in the html file and have the postcode written next to the suburb. Again i have posted this up early as i dont have all the details but this i will definately be needing this within a couple weeks, thanks. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Installation package that will install the software (in ready-to-run condition) on the platform(s) specified in this bid request. 3) Complete ownership and distribution copyrights to all work purchased. ## Platform im lookin for simple java script that will run on as many platforms as possible.