form box with mail

Im very noob in programming and sorry for my english, but i need a desperately help. I want to make a form what have to look like this

i want that the guest enter the text in that box, and e-mail and then he push the submit button it sends my writted e-mail to the guest e-mail and that text what he entered in the box, is coming to my e-mail. After he click that submit button, he is directed to the "thank you, information is sended to your mail." page.
I use namo webeditor, if that helps