480114 Jave / Ajax Form Code Needed - Work without Server Side

Hi, I need a Java / Ajax Web Form Code, which can work on the sites pages without server side and work on the fly. I want to use Form Code on different pages and every page I can define a different email address in the code to whom from data will be emailed. Form Data Fields: Name: Email Address: Message: Upload File: And with captcha check. Form must open after clicking the link at the same place.