I am trying to create a list of items with quantities

I would like to create a list that has a text field at the top, radio buttons, an item and then a field for quantity of that item.  I have tried the configurable list, but have not had luck getting it to look like I want.  HELP?

I have attached a screen shot, but it does not have the "quantity" field I would like. 

Have you tried using one of our payment fields for this?

https://www.jotform.com/help/165-Setting-Up-Your-First-Order-Form

If you do not want the form to automatically process a payment, you can use our Purchase Order payment field. It will provide all the benefits of the regular payment field, such as having your products listed with options and quantity, but without any actual payment processing.

The following guide describes how to add quantity or other options to your products:

https://www.jotform.com/help/225-How-to-Add-Options-to-Payment-Forms

Please try it out and let us know whether this satisfies your requirements.