This is a "mailto" form and for it to work properly you must have your browser's mail preferences (under options, usually) set correctly. In particular, make sure your SMTP server in the preferences has the address of the server that handles your email account. Chances are good that if your email address is you@company.xyz you need to enter company.xyz for your SMTP server.
URL:

Your Name (optional)

Your EMAIL address (optional)

To what location should this URL be linked: