Build me a simple address collecting link on my website

I need to collect name, addresses (address1, address2., city, state, zip, telephone and possibly one more column) from an email blast I am sending to get the home addresses for Christmas gifts.

I want them to click on a link- that takes them there-- or has the fields for them to fill out-- then these names & addresses will be gathered (or batched if need be) to an Excel spreadsheet. Nothing fancy--just a simple data collection program.

The email will be sent by Constant Contact or Gmail.

Thanks