anyone looking to do it i jsut put this code in page 3

tools >>>> define pages >>>>

then page 3 copy and paste the following, also change the buttons to match yours :-)

Code:
 <div class="centerColumn" id="contactUsDefault"> 
  <table width="100%" border="0" cellspacing="0" cellpadding="10">
    <tr>
      <td><p>Simply fill in the form below to register for our drop shipping program, 
          you will be informed within 24 hours about the decision of your application.</p>
        <p>*If you have not yet opened a retail account please do so before submitting 
          your application.<br>
        </p>
        </td>
    </tr>
  </table>
  <form name="contact_us" action="index.php?main_page=contact_us&amp;action=send" method="post">
    <address>
    </address>
    <fieldset id="contactUsForm">
    <label class="inputLabel" for="contactname">Full Name:</label>
<input type="text" name="contactname"  size="40" id="contactname" /><span class="alert">*</span><br class="clearBoth" />

<label class="inputLabel" for="email-address">Email Address:</label>
<input type="text" name="email"  size="40" id="email-address" /><span class="alert">*</span><br class="clearBoth" />

<label for="enquiry">Message:<span class="alert">*</span></label>
    <textarea name="enquiry" cols="30" rows="15" id="enquiry"></textarea>
</fieldset>

<div class="buttonRow forward"><input type="image" src="includes/templates/13271/buttons/english/button_send.gif" alt="Send Now" title=" Send Now " /></div>
    <div class="buttonRow back"></div>
</form>
</div>