Build Me a Nice Contact Form $25

[srockhard]

I need a contact form setup on my site. There will be less than 15 fields including an image upload option. I would like all data emailed to me when the user clicks a submit button. User will be redirected to a confirmation page (already built).

I've already got a dysfunctional form setup that I attempted using the FormMail.pl cgi script and the design of the page is already done and ready to go. I would like the form to look somewhat modern and easy to understand (perhaps using some padding to enlarge the fields?).

I know there is someone out there that is a whiz at this but I just can't figure it out. $25 (negotiable) for any takers.

[srockhard]

Freelancer.com solved in about 15 mins ;)