do you have a template like the link below or can create on

do you have a template like the link below or can create one

There are many templates you can find in our templates gallery: http://www.jotform.com/form-templates/

If you do not find one similar to the one you want, it would be easier to start  creating it with our form builder in a matter of dragging and dropping fields:  http://www.jotform.com/help/2-How-to-Create-Your-First-Web-Form

You can further style your form with our form designer: http://www.jotform.com/help/300-Form-Designer-Tutorial-Let-s-create-fantastic-forms-

Let us know if you need more help, we will be glad to assist you.