The email FROM has to be an email address. It should be set to a valid email address from the same server as the website that is sending it or else it will likely get marked as SPAM. You can use the REPLY TO from the form if you want to be able to reply to the email and have it sent to the person filling out the contact form. Right now you have the from set to the name field and that would never send since it isn't an email address at all.
Did you upload the page: webassist/email/templates/WebAssist-Block/Block_5.php
If that page wasn't uploaded, then it could cause a blank page. Sometimes you can get more information by adding this to the top of a blank page:
<?php ini_set("display_errors",1); ?>
Sometimes a blank page means the page has an error, but you have display_errors turned off and by turning it on you get more information about the error type and line number.