292747 php form with attachment

I want a form where users can fill in the following: Full Name Age Date of Birth Telephone Address (textbox) Email Attach Image: with upload button This form and attachment must be mailed to 2 users. This form will run on a linux server with php5. PM if you have any questions. If you use a script that I must install I would like some instructions as you wont be able to get access to the client's server.