ASP Email Form

I need an asp form to send via email!! I would normally do this on my own but I'm a bit backed up with other priority projects that I am working on. Please see Image below for an example of what I need. I don't need it to be exact, but I do need it to close to the image I provided. The email needs validate. *Note: No php, I need it done in ASP, I will require all the code plus the [login to view URL] file. Thank you *I need it to redirect as well, don't worry about the link to redirect as I will edit once I recive the code. Applies to the mailto and sendto field as well.