The HTML source below represents a simple comments form. This form can be customized for your Virtual Server by simply changing the occurrences of the email address (shown in bold) to the address that you would like to use in the form. It may be necessary to add an e-mail alias or e-mail mailbox if you use an e-mail address that does not currently exist on your Virtual Server. 
  <html>
  <head>
  <title>Send Comments / Request Information</title>
  </head>
  <body>
  <h3>Send Comments / Request Information</h3>
  <hr>
  <p>
  Feel free to send us your comments, suggestions, and/or questions.  
  We value your input and desire to make these pages as useful as possible.  
  Please leave an E-mail address so we can reply to you.
  <p>
  If your web client supports the "mailto" URL, you can use your
  <A HREF="mailto:email-address@your-domain.name.">local mail app</a> 
  to compose and send a mail message.  Otherwise, you can use 
  the form below.
  <p>
  For those using browsers that do not support forms such as this, 
  send mail to: <em>email-address@your-domain.name</em>
  <p>
  <hr>
<form action="/cgi-bin/fmail.pl" method="POST">
<input type="hidden" name="recipient" value="email address you want form sent to">
<input type="hidden" name="subject" value="Name of Form">
<input type="hidden" name="thankurl" value="http://www.yourdomain/thankyou.htm">
    
  <font size="+1">Your Full Name:</font><br>
  <input name="name" size=50>
  <p>
  
  <font size="+1">Your E-mail address:</font><br>
  <input name="username" size=50>
  <p>
  
  <font size="+1">The Subject of Your Message:</font><br>
  <input name="subject" size=50>
  <p>
  
  <font size="+1">Your comments, suggestions, and/or questions:</font><br>
  <textarea wrap=physical name="comments" rows=8 cols=50></textarea>
  <p>
  
  <input type="submit" value="Send comments">
  <input type="reset" value="Clear">
  <p>
  
  </form>
  <hr>
  </body>
  </html>
The form shown above represents the minimum amount of information that a comments form should contain- namely "recipient, name, email, subject, and comments". Other information can be added to the form above.... this information will also be sent to the "recipient" specified.

If you are unfamiliar with the FORM HTML element, or would like to learn more about forms, the following URL is an excellent resource:

http://www.ncsa.uiuc.edu/SDG/Software/Mosaic/Docs/fill-out-forms/overview.html