I need a simple opt-in form code for my epicsqueeze page

I need a simple opt in form code for my epicsqueeze page.

Id like the person to enter an email in my epicsqueeze page, press send, then the email is saved to a database, or just emailed to me. I just want to stay away from getresponse, aweber etc for the time being. So I just want the emails.

Ideas on some simple code to just paste in..?

Two questions:
1. Will php work?
2. If yes to #1, can you upload a smtp php file to the server?

If you just want to collect emails and not use an auto responder, then use the Contact Form 7 WP plugin and edit the fields (very easy) as you see fit. The emails will go to whatever email address you want

Don't see where OP said that WP was being used. If so then yeah contact 7 is the way to go.