Just wondering

I have a custom form I need to build, it needs to look like this:

Last Name _________________________

First Name _________________________

Street Address _________________________

Street Address (cont) _________________________

City _________________________

State _________________________

Zip Code _________________________

Home Phone _________________________

Work Phone _________________________

E-mail _________________________

Select the reason for your return: Exchange for a different size
Exchange for a different style
Exchange for a different style and size
Return for a refund minus restocking fee
Defective: Explain below
Other: Explain below

If exchanging for a different size? _________

If exchanging for a different style and size? Style _________ Size________

Please include any additional
information that would be helpful
in processing your request.



Submit Form Reset Form

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Here is what I did....
I copied the Contact Us form (standard with OsCommerce) and renamed it to returnauth.php

I copied /catalog/contactus.php and renamed it returnauth.php

I defined Return Authorization Form as returnauth.php in /catalog/includes/languages/english.php

Next, I copied /catalog/includes/languages/english/contactus.php and renamed it returnauth.php

Lastly, I defined returnauth.php as Return Authorization Form in /catalog/includes/filenames.php

Ok.........all great and good till now.......
Now, I need two things:
I need the results mailed to returns@thingsofdistinction.com
and I need the form to look like what is posted at the top of this message...