Sanjay Bandhniya We implemented similar functionality in the past. In the implementation we extended the login page and provided a "Contact Us" link.
On click of the link, a html (iframe) form opens and user provides required details and click submit.
We implemented a POST Webscript which authenticates as a "guest" user. The web-script validates the inputs (character limits, XSS Attack and SQL Injection types) and saves the details in a dataList node. If input validation fails it cancels the requests.
We implemented an option on Share Admin Console to display the data list as a table so admins can check the submitted requests and export as a excel/csv.
We had two levels of validations, one on html form itself where we limited the characters user can enter and validate harmful content and second level was on web-script side (as it is accessible by guest user).
You can implement on similar lines if that suits your requirement. Make sure you have necessary validations of user inputs.
(ACSCE, AWS SAA, Azure Admin)