Create Contact Form on DNN

I need to create a new page with a form on this site: [login to view URL] We are using a DNN content management system. There is a similar form already on the site here: [login to view URL] ( we are not replacing this form, this is just to show you an example) The new form should have the following fields: Title: Family Law Case Inquiry Form Name Contact Info. (email and phone). Date of Marriage Date of Separation Number of children Age of oldest child Age of youngest child. Your employment. Other party’s employment. Have you already filed an action with the court? If so, has a judgment already been entered in your case? How did you hear about us? This will just be emailed to a designated email address. Nothing needs to be store in a database. I have all login info and will provide that once we move forward. Thanks, -Andrey