Please help to make a better feedback form.

I want to add a feedback page to my web site.
Currently my web site have a feedback form that made with thesitewizard.com feed back form making tool.

But I want a more advanced feedback scripts that should have
1. Identification of user country
2. An IP address can submit only one submission through the form.
3. User's country should also send with the feedback e-mail.

I really appreciate that, if any one can make a script according to my requirements or direct me to a script that enable these thing.

Also I can give you a price for the script if it works according to my requirements.

Thank You.

 

I Can create such a thing for u whats ur budget ?

 

There are loads of softwares out there that will do this for you without any knowledge of html/java.

 

this feedback/contact form should work according to my requirements.
just show me an example of your work and then i'll specify payments.