Add form to request catalog

Would like an easy form added to request a catalog. Basic information needed from customer input: Name; Organization; Street Address; Address (cont.); City; State/Province; Zip/Postal Code; Country; E-mail. Would like information that customer inputs to be stored in a table. Forms input would be forwarded to a specific email with; Re: Requesting Catalog. I have a picture of the current catalog to post on the page also.