Pop-Up Contact Form In Php

I need a pop-up contact form script created in php. Pop-up form must work across all browsers. The script will allow me to create and manage multiple contact forms from the admin area. Each contact form created will provide me with a small script which I can place on any page or domain in order to open the contact form on that page. A protected admin area is needed where I can add, update, and delete contact forms. Each contact form created in the admin area will have a title, subtitle, body text, name field, email field, privacy text and submit button. A database will track the submissions for each contact page. Each submission will be emailed to an email associated with that contact page. The script will track the views for each contact page. I need the option to add an image to the background of the contact form. The option to disable a contact form from the admin area is needed.