531110 Simple Email Contact Form in php

I need a Contact Us form built in PHP, and to email certain people, depending on what choices from 2 different drop down boxes.

The form will have the following:

First Name (required)

Last Name (required)

Phone (required)

Email (required)

City

State

Organization/Company

Select a Location (depending on which choice, it will email a different person)

-Bakersfield – emails a list of email addresses (needs to be configurable somewhere)

-Bay Area – emails a list of email addresses (needs to be configurable somewhere)

-Fresno – emails a list of email addresses (needs to be configurable somewhere)

-Los Angeles - just like above, and for the rest of below, etc. etc.

-Modesto

-Orange County

-Riverside

-San Diego

-San Gabriel Valley

-San Jose

-Corporate

-Other

THEN, in addition to the choice above, there is a second drop down box:

Select a Topic

-Programs and Services – emails a list of email addresses (needs to be configurable somewhere)

-Donate – emails a list of email addresses (needs to be configurable somewhere)

-Sponsor – emails a list of email addresses (needs to be configurable somewhere)

-Volunteer - just like above, and for the rest below

-Employment

-Media Website

Comments

Submit button

Reset Form button

So the final form result will email all the email address from “Location” drop down box, as well as email all the email addresses from the “Topic” drop down lists.

We would need the ability to add/change/remove any email addresses for any of the Locations or Topics. (needs to be configurable somewhere)

Odd Jobs PHP

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