Easy Form for reservation

I need an easy form with the following content: - Date selection (DD/MM/YYYY) * - Time selection (24hours) * - Drop down box to select up to 6 options * - Title - Surname * - First Name * - Company - Tel - E-mail * - Comments box - Tick Box to choose, if newsletter yes or no Content has to be sent to an e-mail address in a nice readable format. * compulsory fields