Customer Feedback web page

We need a customer feedback form added to our website. It will be a very simple form with? criteria for the customers to rate our company on and then boxes the can check to say whether? they think we are excellent, good, average....etc. There will also be space for customer feedback.? When we recieve the customer form we can add it to our database and post Testimonials on our website It will require very little graphic work as it will need to visually comply with the rest of our website. Looking for a quick turnaround on the project