PHP report dead link script link - know of one?

[guysmy]

I have a site that plugs time sensitive deals and sales so its crucial that I allow users to report an offer (or link) that is no longer working (not interested in a bot script that checks for dead links).

I need a script like this:
http://www.perfectscripts.com/report/dream-catchers-form-return.html

Oddly a few other script sites are running it but I can't seem to locate the source code. Thanks beforehand.

 

[logiik]

I tried Googling but nothing came up for me.

It's just basically a contact form right? Couldn't you just get the source on tutorial sites for a contact form and add in a line of code where it displays the current URL or something.