This question was asked "verbatim" on the perl.beginners list, and I gave him/her a rudimentary script. I guess the poster is looking for a "free script writing" service.

These kind of simple CGI scripts are so common that you could find 10 or 20 good examples if you searched groups.google.com for "perl cgi mail".

You could also look in the Snippets section here on Perlmonks, and look thru Grinders snippet index at snippet index. Then look for things under mail....like "Generic Mail Form Processor" for a start.