We have a couple of ways you can accomplish this. Using the Form Builder along with Universal Email you can create a form that fits your needs then you can use Universal Email to send the form information in an email. If you are interested in doing it this way we have a Solution Recipe for Universal Email that details the steps you would need to take. It can be found the the support page for Universal Email in the Solution Recipes. Here is a link to the support page:
universal-email/
Another way you could to this would be to use our Contact Form Solution Pack. It has a form the user fills in and sends the results to whomever you would like. Here is a link to the page with more info on this:
contact-form/