Create web form that sends email via SMTP

I need a web form where I can have data entry staff visit a page, type in a value (say "product name") and have a pre-specified email sent out via the SendGrid SMTP servers/API with the "product name" dynamically inserted into the email contents. Additionally, the contents of the email need to be modified to choose one of several options for each paragraph. Here is an example as to how I see the tool working: Data entry worker visits his designated page for his email address: /sendgrid/[login to view URL] - meaning only John Smith will use that page (all email sent from that page comes from John Smith's email address Worker inputs the product value at top of page in a test box so the data can be inserted into Subject and Message: "Product557" Worker inputs the Recipient email address in the "To" field Subject gets autofilled to state: "Product557" Message gets autofilled to: Hello, Paragraph1 (Script randomly chooses 1 of 5 possible Para1 options): This email is about "Product557" ... Paragraph2(Script randomly chooses 1 of 5 possible Para2 options) Paragraph3 (Script randomly chooses 1 of 5 possible Para3 options) Worker then clicks Send and form passes along the message to SendGrid servers to be delivered. See SendGrid API info: [login to view URL] After the transmission is successfully sent there is an indication of SENT and the page immediately refreshed to be filled out once again. If there is any hang up the page lags and does not refresh or provide any success message. Failure message provided after period of time is exhausted or if any error occurs. It is pretty simple and straight forward to me but if anyone needs clarification please do let me know.