Looking for someone to create Contact form in modal window. No Indians, please!

I need a contact form which will send info to my email.
The form will have only three required fields: Name, Phone number and Email Address. And Submit Button.
All data has to be sent to my email address.

The form has to appear in a modal window. I have a desgin of the form already.
I need someone who could write a code to make it work.

I will not work with those, who are not fluent in English.

My budget is 500 USD for this.

My Skype ID is: zafar_12

Thank you.