Leave a reply form

Hey Yola! Happy 11
I would like to make a new question. Will you create a simple "leave a reply form" like this http://i55.tinypic.com/2dbnjaw.png in "Forms and Appointments" Widgets? The simple form is a great tool but i would like simple reply forms for my pages in which i can delete the "bad" messages. I don't like "disqus" or other same solutions. Thank you.
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