A: 

If you want it to be available on every page, you might want to consider using jQuery and the UI Dialog plugin. You could set it up so that the default feedback is a mailto which gets replaced using javascript with a link that brings up a jQuery Dialog containing the fields you want to collect. This could be submitted back to your server via AJAX and delivered to you via email from the server.

EDIT: Since you've edited your question to indicate a server-side only solution, the above seems somewhat out of context. With others, I would agree that using some client-side code to actually send the email is the way to go (as alluded to above). I think it's preferable to use your own server for this, but I'm sure that you can find many "form to email" services. I would avoid these, unless you want your email addresses harvested for use in SPAM. You might also be able to use a signed applet or ActiveX control for this, again I would not go down that route. As indicated above, I would let the browser handle the interface, but my server handle the sending of the email.

tvanfosson
+2  A: 

You should use a server-side script (e.g. PHP, Python, Perl, etc.). With pure HTML and JavaScript, you can use a mailto form, but this will be very unreliable.

Matthew Flaschen
A: 

I am not sure i understand your question completely, but if all you want to do is conduct a survey over email, i don't think you need to use jQuery or HTML.

A very simple way to do it is to use the 'Forms' feature in Google Docs.

Anirudh
I want to have full control over it. Using my own code would allow for this.
Lucas McCoy
+1  A: 

I will suggest uservoice.com , it can integrate with your site nicely, a much more powerful user feedback system, without spending time to code the feedback system yourself

Unreality
A: 

As others have indicated, this is a typical task that can be solved easily using a server-side language. Javascript and jQuery aren't the right tool for this particular problem. To point you in the right direction, use method="post" for your form, and you can access users' submission in a PHP file by examining the $_POST variable. If a <input> element in your form has name="email" in your email, you can access that variable in PHP as $_POST['email']. If you're interested in a PHP solution, look at the documentation for the mail() function.

Ryan
A: 

Jukka has a good guide on How to write HTML forms. It should give you everything you need to produce something functional.

You need a server side component, nothing client side will be a reasonable substitute for that. JavaScript won't help for a form as simple as the one you describe.

David Dorward
A: 

The most reliable way will be to use a server side script in your preferred language. The specifics of how to do this are probably outside the scope of this question and would depend upon your language of choice.

Your other option is to set the action of the form as a mailto: which will use the visitors preferred email client to send the email. This will work but is really bad and relies on the viewer having an email client installed and configured.

you can find out more information about the mailto option at http://www.chami.com/tips/internet/010597I.html

Another good option would be a third party site such as www.wufoo.com which handle all of the email business server side for you on their own servers. I believe Wufoo even allow you to embed their forms within your own site.

Craig Bovis