Create a Submit form and upload to webhosting company

I need to have a submit form for my website [[login to view URL]][1][login to view URL] I've had one coder start the form with the items that I want on the form.? You can see them at: <[login to view URL]> The person has become too busy to finish and I would like to have this completed soon. I'm looking for someone to use my website information to create a form using my webite info.? - I would like for the form to validate information such as name, phone number and email address.? - After submitting the information, I would like for the form to have a message box pop up saying: Thank you for your interest in Lasara Management? Group (LMG).? Our Someone will contact you with additional information soon.? You can also contact us via phone at 818-749-2637.? ? Regards, Lasara Management Group? (This can change, I need to finalize my message).? ? ? - I would like for them to? redirect? to [[login to view URL]][2]m - I would like to have the information emailed to me in an easy to read way