gistfile1.txt

<form action="http://localhost:3000/submit/your@email.com"
      method="POST">
    <input type="text", placeholder="Name", name="user[name]">
    <input type="text", placeholder="Email", name="user[email]">
    <input type="text", placeholder="Mobile", name="user[mobile]">
    <input type="textarea", placeholder="Message", name="user[message]">
    <select name="queryType">
      <option value="A">A</option>
      <option value="B">B</option>
      <option value="C">C</option>
      <option value="D">D</option>
    </select>
</form>