112188 Need Email Form

I need an email form that will have 5 email fields (where 5 email addresses will be entered) and a seperate email field (the user that is submitting the form email) The user enters 5 different email addresses, as well as their own. When the user clicks submit, a paragraph of text (I will need to be able to edit this via a simple admin on my server or via a text file through ftp) is sent to all 5 email addresses (none sent to the user) and a confirmation email is sent to me, containing the 5 email addresses plus the submitters address. FORM FIELD TITLES: Friend / Family 1: Friend / Family 2: Friend / Family 3: Friend / Family 4: Friend / Family 5: Your email: SUBMIT ----------------- Need form page to be in .html, but function can be in php or whatever you prefer. Final function: on each new confirmation email that is sent to me (with the addresses) I would like it to display how many total users have been sent to (each form x 5, for the total sent) via a counter function at the bottom of the confirmation email. Total People Sent to: Looking for lowest bid and positive ratings. Please do not bid if you cannot perform all functions successfully. Thanks! Ryan