Create a On Line Form

I am looking to create a online form which will then be placed on my website and could be completed by my clients and submitted to me

I have attached this form which will also have to rebranded to me. My site is www.dogharmony.co.uk

A good example of a online form is


https://thekennelclub.formstack.com/forms/applicationfortheregistrationofanimporteddog_form_4

A cost please