Is it possible to change the full layout of a form?

I realize this may be very advanced but it's worth a shot. I want to create a content submission form but I want the form to look like this wireframe:

I want the be able to adjust the forms html so that I can place images, and text fields together based on the content it relates to.

So, I want a text field that spans the width of the form up top. Then on the next row, I want to put an image upload area on the left. Next to that, two text fields for the sub-header and content. Then a text area for the buttons URL

Is this possible at all? I would greatly appreciate any feedback.

Thank you in advance!!

This requirement may be possible by injecting custom CSS code to your form after adding all the required fields in the Form Builder. Also, you may adjust the fields to display on the same line by positioning the fields on the form. Please refer to the guide below that can help you with field positioning. 

http://www.jotform.com/help/90-Field-Positioning

You may also take a look at our Theme Store for more designs that you can apply for your JotForm. Let me see if I can work on a form to fulfil your requirement and get back to you later.

Hope this information helps!