Service That Runs Secure Contact Us Pages for Companies?

Do you know of any third party service that runs a simple "contact us" form
as an outsourced service for companies? The main reason to outsource such
a simple function is to make it the third party's responsibility to always
keep the back end system up and running.

The specific requirements we have:

- Each Contact Us page needs to be customized for the destination email to
which the form output will be sent.

- There should be some provision for web analytics, so we can record facts
about where the Contact Us request came from.

- There should be some fairly sophisticated challenge response
authentication of a live user making the Contact Us request, so that we are
not bothered by spammers and hackers trying to do denial of service attacks.

- There should be some provision for either developing a questionnaire or
taking the user through some logic path prior to the form submission.

- The back end databases, file systems, and networks should be monitored
24x7 and never allowed to come down for more than 10 minutes a day.

- Price per month for under 1000 Contact Us requests should be under
$50/month.

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Will