I saw that you were doing this for someone else, and it's exactly what I need as well. I need a form that allows a user to browse their computer for an image and upload it. The image should be sent to my email address when the user hits the submit button.
Also need the following form fields:
Title: (form field)
Description: (text box - max. 200 characters)
URL: (form field)
That's it. Thanks for your consideration.