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If you have any experience in PHP, its really not too hard...
Basically, you'll need an HTML form with a text field for their email address, and other text fields for whatever other info you need. Then you'll need a drop down menu for what they want information on.
From there, you'll need the PHP file which is the 'action' for the HTML form.. In that you'll have to get the POST data from the form, and then do some text manipulation to combine the users data with the pre-defined emails(ie making it say "Dear *users name*", etc..) and then use the PHP mail() function to send out the email to the address they specified.
If thats over your head, shoot me a PM... We can work something out.
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