Need someone to make a simple Report Abuse/Spam script

I need someone to code me a a script on its own page.

I want to be able to ad a link at the bottom of my lander, that says 'Report Spam or Abuse'

This will them take them to an official looking page where they fill out a few details.

I want the page to have some legal canspam crap on it. Then have the following fields.

"Name"
"Email Address"
"Zip Code"
"Describe the Incident or Infraction"

I then want them to be able to submit this and it should just be written to a text file or something. It should then take them to a confirmation page after they submit it.

Let me know, PM me, this should be an easy 25$ for somebody.

Im in for this too

I can do this for you if your still interested just shoot me a PM.