I will build a contact-us form for only 0.0027 BTC.example :
I can remove fields or add fields(5 Maximum)
Features :
1. clean and easy to read code
2. you will recieve messages into your own email
3. Email filtering(to check if input is email or not)
4. you can make Email banned list
5. you can turn off the service easily and with a custem error message
6. you can limit max charectars of any field to specific number
7. if you want i can prevent the bot that randomly fills the form for only 0.0003BTC added to the price
you just need :
PHP 5.0(or higher)
SMTP server (you must have Host, username and password)
if you dont have SMTP server you can ask your hosting company if you can get one or any other SMTP server provider (like google)
paying after i complete the task