Do you need this? This juss a sample one!
Juss copy the the code,and change the one where it says so and paste it on ya site!

<form action="http://response-o-matic.com/cgi-bin/rom.pl"
method="post">
<INPUT TYPE="hidden" NAME="your_email_address"
VALUE="YOUR EMAIL ADDRESS HERE">
<INPUT TYPE="hidden" NAME="your_name"
VALUE="YOUR NAME HERE">
<INPUT TYPE="hidden" NAME="email_subject_line"
VALUE="TITLE OF EMAIL HERE">
<INPUT TYPE="hidden" NAME="required_fields"
VALUE="your_email_address">
<INPUT TYPE="hidden" NAME="thank_you_title"
VALUE="thanks for submitting! i'll get back to you soon.">
<INPUT TYPE="hidden" NAME="return_link_url"
VALUE="javascript: http://YOUR URL HERE">
<INPUT TYPE="hidden" NAME="return_link_name"
VALUE="Click here or click back until you get back to where you were">
<input type="text" name="name" value="name"><br>
<input type="text" name="e-mail" value="email"><br>
<input type="text" name="homepage" value="http://"><br>
<input type="text" name="comments" value="comments"><br>
            <input type="submit" name="send" value="send"> <font size=1><input type="reset" name="reset" value="clear">
</form><br><style type="text/css"><br>  <br>  </style>

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