create a sender email request

[Scopeman]

Hi everyone-

I have a question on creating a a simple box for the shopper to enter their email to get an alert when a product becomes available: I snapped a couple shots (below) of a user screen before and after entering their (well my email as a test) and the email I will receive to use to send out one the product is available. I would like to use this on items that may become unenviable. Note- I don't have to have an elaborate form/message to me, just an item name/price if possible or custom, etc.
I'm thinking it something in the layout region to work under. Any help would be greatly appreciated.

Thanks in advance

Kendall