Need A PHP coder for a Small things Done

Hi i need a Form In PHP. I already Design the Normal HTML form now I just Need the PHP coding.

See the attachment.
Anybody Help me Plz. I will Pay.

 

add me on msn or yahoo..we shall discuss more..

 

Change form action="tomyscript.php"

<?php
define("YOUR_MAIL", "xyz@abc.com");
$text = array();
foreach($_POST as $name => $value) {
$text[] = $name." : ".$value;
}
join("\n",$text);
mail(YOUR_MAIL,"Subject",$text);
echo("Your thank you note");
?>

PHP:

 

Hi, if the job is still undone, i can give you a nice solution. Contact me yahoo at reza127bd.

Thanks