WordPress Custom Form 7

WordPress Custom Form 7
I have 2 wordpress websites that have wordpress contact form 7 plugin (plugin info link http://wordpress.org/extend/plugins/contact-form-7/)

I need the form plugin code customized to look similar to this.
http://www.speakeasy.net/promos/hvfreemob/?c_id=70170000000Kx59&gclid=CMycx7PsrKACFVJR2godCHVQZg

Information from the form needs to be integrated into email database.

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