Custom Contact Form Script

I need a PHP script that will allow my site visitors to send me messages, with a custom subject and which will direct their message to an appropriate email address. For example, if they'd like to contact "Sales", they would select Sales in the subject selection box, and their message will be delivered to the sales address. The email addresses will be encoded in the script itself, so they will be hidden. 1. Fields: Full Name, Email address, Select Subject, Message body, text captcha, Add to mailing list checkbox, and Send button. 2. The text captcha will consist of a basic javascript that will ask the user to enter a word backwards in the edit box to pass. 3. The script should be self-contained in a single file. Please include blocks of HTML that I can customize with a message receipt such as "Thank you, your message was sent successfully". Also, an error message. 4. Make it easy for me to customize with different subjects and possible email addresses, and please use basic CSS. 5. Messsages will be delivered to me in plain text for simplisity with the results, and user IP/ID info if possible. 6. Please make sure it can't be compromised. ## Deliverables 1) Complete and fully-functional working program(s) in executable form as well as complete source code of all work done. 2) Deliverables must be in ready-to-run condition, as follows? (depending on the nature? of the deliverables): a)? For web sites or? other server-side deliverables intended to only ever exist in one place in the Buyer's environment--Deliverables must be installed by the Seller in ready-to-run condition in the Buyer's environment. b) For all others including desktop software or software the buyer intends to distribute: A software? installation package that will install the software in ready-to-run condition on the platform(s) specified in this bid request. 3) All deliverables will be considered "work made for hire" under U.S. Copyright law. Buyer will receive exclusive and complete copyrights to all work purchased. (No GPL, GNU, 3rd party components, etc. unless all copyright ramifications are explained AND AGREED TO by the buyer on the site per the coder's Seller Legal Agreement). ## Platform PHP, Linux server