Contact Form for easy customization

I’m looking for a contact form plugin that can easily be customized in terms of layout and style.

I need a contact form that can be used as a normal contact form around the website but also be able to do something like this.

https://img546.imageshack.us/img546/8526/callbackform.jpg

Contact form on the right perhaps in a widget area with links on the left maybe bringing up another contact form or taking you to another page with a contact form on it.

Any ideas for plugins which could easily do this?

Thanks