Need easy code for contact me form

Looking for someone who can write me code/script for a contact me blog post for my wordpress blog hosted on hostgator.

Very simple -- name, email, website, comments and like 5 or 6 checkboxes they will have to check. All I want for the code to do is send all of the information to my email.

Let me know if you can do this, and how much it would cost via paypal?

Thanks!

I can do this for you, check PM.

check your pm