Email Support Request Form

We need a email registration, support request, and management system. The support request form will be sent to more than one email per support section like software, hardware, & networking plus a bcc will be sent to the system mail specified by the admin. The admin should be able to add and take away emails with ease. For example, software support request could have 10 emails and hardware could have 5 emails that are different from software emails. You can make the form with 5 top selections like a, b, c, d, & e. The email form should change based on the top selection. The layout of the form should be as described below: Select what type of support you need: Drop down menu Name: (required) Address: city - state/province - country with US as default (not required) Phone: (required) Fax: (not required) Email: (required) Comments: (not required) Agree: Terms (required) - Check Box Send Button The email form should also have some dynamic elements to it based on the top selection of software or hardware. The admin should be able to add additional questions that are selection specific. For example, if the user selects software, there could be a question like what software are you using. Likewise, if hardware is selected, we can ask about user's hardware. All the emails collected by the request form should go to a central mailing list (mysql) from which the admin should be able to send newsletter based on users' preferences like software or hardware. This is a small php mysql project. We already have the know how to do this in-house, but there is not time to do the trial and check the script for errors. If you are an experienced developer, this should not take you more than a couple of hours.