What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you’re getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you’d like help immediately, feel free to search for a similar question, or submit your question or concern.
I am not quite sure if I understand what you are after and for that reason I have created a sample here:
It is using Configurable list
You can see how to set it up here: How to Set Up the Configurable List Widget
Do let us know if that is what you were after or if not, do give us a bit more details and we would be happy to assist in either case.
In case you are used to responding through email, I would advise to come to this thread instead as at the moment our maintenance team is working on a part of our system, which could lead to us not receiving your response sent over email. This is the link to your thread: http://www.jotform.com/answers/490093