Addition of manual search + contact form

I require a contact form with the following fields added to my [login to view URL] page Name : E-mail : Retype E-mail : Department (drop down list) - Sales - Support - Distributor / Reseller - Press / Media - General Inquires Message : SUBMIT | CLEAR buttons I also require a manual search with search field to be located in menubar on far right next to contact us. Results will be displayed within search page.....