<?php
if(isset($_POST['submitted'])) {
    $message = 'This is a Testmessage by '.$_POST['Name'];

    $email = 'root@localhost';
    $username = 'root';
    $password = '1234';
    $mail_method = 'stmp';
    $smtp_host = 'smtp_host'; // e.g. localhost
    $smtp_port = 25;
    $to_email = 'mail@receiver';
    $sendmail = new Email;
    $sendmail->protocol = $mail_method;
    $sendmail->smtp_user = $username;
    $sendmail->smtp_pass = $password;
    $sendmail->smtp_host = $smtp_host;
    $sendmail->smtp_port = $smtp_port;
    $sendmail->mailtype = 'html';
    $sendmail->from($email, 'test name');
    $sendmail->to($to_email);
    $sendmail->subject('Mail form on site: ' . URL_PUBLIC);
    $sendmail->message($message);
    $sendmail->send();
} else { ?>
<form method="post">
<input type="hidden" name="submitted" value="1" /><br />
<input type="text" name="Name" value="" />
<input type="submit" value="Submit feedback" />
</form>
<?php } ?>