JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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Sn Cus Name Service 1 2 3 Customer Signature
1 abc * * ****** Submit
2 abc * * ****** Submit
3 abc * * ****** Submit
Though I am not completely sure what you are looking for, our configurable list widget would be able to create a field similar to what you have in your screen shot:
We also have many templates to help get you started:
If you could let us know a bit more detail regarding how exactly the form should be set up, we can likely help you with whatever you need to add.