Contact Form with PHP Script

We are looking to enhance the current contact form that can be viewed at: [login to view URL] The form is HTML and the script should be PHP. We want the contact form to have the following fields: These ones are mandatory fields and there needs to be validation to ensure that they have been populated Your full name E-mail address Your telephone Company name These fields are check boxes and are option fields but at least one of them must be selected. The default value is for them to be blank: PerTOOLS Financial Analysis for Excel PerTOOLS Data Extractor for Excel The following field will be a list (we already have the values that need to be in the list and can provide them): Country When the user selects the submit button there should be validation to ensure the form has been correctly completed. we want an email to be sent to two different addresses. The first email is to our email address and every time the form is submitted this address should receive a copy of the details. The second email address will depend on which country the user has selected (e.g. if a user selects USA the details go to one email address, if they select the UK the email goes to another address). For the look and feel of the form, please look at the current one at: [login to view URL] Feel free to ask any questions. We are looking to get this done as soon as possible.