How to create a ticket with a web form using customer email and name?

Hello,

I have an instance that I am trying to set up so that it can receive tickets via a web form on a website. The web form is basically a complaint form that customers can complete and submit on our website. My question is, is there a way to make it so that the ticket created via the form is created with the customer email and name as the requester? Currently it is showing my support email as the requester. Is there a way around this? All suggestions would be appreciated.