Form Created for Email

URGENTLY needed in next few hours. Should be fairly simple project. I need an form that can be added to a webpage that will do the following: 1. Send form contents to a particular email address 2. Send a blank email to another email address that will trigger an autoresponder to send an email to the person completing the email. Example: Mrs B comes to my website and wants a report that I am offering. She completes the form. I get the information she supplies sent to me via email and Mrs B gets the report via autoresponder.