Need help to create a simple form

I need to recreate this exact form in flash, but my server only support asp (not php):

http://www.beths.no/forhandler/finans.php

(It´s in norwegian, but I hope you get the idea)
It´s a contact-form where people can fill in their personal information and click "send "which then generates an email to a specified address.

Hope someone can help me with this :slight_smile: