how can make this page ?

how can make page , contact us with details sam this
replace xx with tt

another question please , does this company price very high ?

Um.. thats a pretty ugly site so i assume you are talking about the form.
Well dreamweaver for both is what i would use.
And i generally use php form wizard to create the script for the form.
There are no doubt better tools for the script.
Like Notepad
But here is the program php form wizard just incase thats what ya want.
http://www.damink.com.au/board/imagefiles/php_script_maker.zip
It is a full version that i bought some time ago.
One of the few programs i ever paid for.
What a knob i know.. oh well......