Is it possible to create customized form?

gentlemen:

tthis is the form that i need to create so with one click of a linked button, it opens this up online and can be emailed after filling out is completed. is this possible with jotform? thank you for your help.

 

Hello grace,

Yes it is possible to create similar form in JotForm. 

I will start working on your form which will be very similar to the screenshot you have shared. Since we can work on such request only in our free time, it will take sometime for me to complete your form.

I will get back to you on this soon.

Thank you!

good morning ashwin,very delighted to get your response so quickly. no rush on the form. i was pleasantly surprised that you even offered to create the form. that is mighty kind of you.kind regards,grace yow, president__________________________Office:623-755-6021TorqueTrends.com
...

Hello Grace,

You are welcome. 

I will get back to you as soon as I am able to complete your form.

Thank you!