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It seems that you are trying to create a contact form so that visitors can contact you by email which is a good thing to do, however there are many different ways you can go about doing this, and without having to learn all the tricks of the trade unless you have a lot of experience in this line of field.
If I were you I would look for a already made script that will allow you to make those changes and lay it out the way that you want, and give you the tools to work with, many hosting companies now offer form creator for your power tools, within your hosting account control panel, but then again if you don't know how to apply the code and add the fields properly then you are going to need to learn how.
I would first see what is out there for creating your contact form, there are many scripts out there, to use, I would give you some links but I don't want to cross the line here.
If you would like you can PM me and I can give you some details on how to do some of this, and where to go to learn more about creating contact forms for your websites.
good luck.
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