JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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.
We do not have a fax number that you would send this to and we can only assist in building the form, we can not make it for you.
If you do give a try using the form builder you will see that it is very easy to actually do the same.
OF course, if you have any questions or issues along the way, just let us know and we would be happy to assist with the same.
I do suggest checking out the following guide: How to Create Your First Web Form