website ''contact us'' page fix/correction

last few years, we were using the following page for website contacts to complete, then auto email to us and cc/copy the contents to the customer too; <[login to view URL]> as you can see below, the contents arriving via email have become incomplete and the two people who helped configure the website have moved on to bigger/better work recently. here is a recent sample failure, from just today; XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX SAMPLE EMAIL RECEIVED [login to view URL] Monday, October 10, 2011, 10:48 am [EST] Thank you for contacting Supreme Systems. This automatic copy confirms receipt of your information sent to us, as listed below: Sent by: at Your Name: Your question or comment received was: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX i need to have someone help me correct this problem, as you can see, the fields of information are not being included/sent. i need the same content; 1. recorded IP, 2. date/time stamp from when it was submitted, generic text above (we have received msg), and customers/inquirers content of; 3. their name, from page field, 4. their email address, from page field and 5. their question/concerns/inquiries, from the last field on the page also, when submitted, need to have emails automatically sent to 3 parties, including a CC to the customers email the website currently uses whm, cpanel and frontpage extensions. i dont recall when this broke, or if the "contact page script is javascript, html or php or ???", but those are the last known programming languages used on the website. would like to have this corrected as soon as possible, but i will allow some time to complete, say 5-7 days. as part of this project, the selected coder will be given "full access" to the site as/when needed to complete this project outlined above. with such access, comes responsibility...please see deliverables below; any questions, please ask in advance.