I need a form creating

Information for the business: Estate Agents
Design details: I need a form creating which i will take out to valuations. I require our header on the top of the form and i will provide all the necessary information which will go on the rest of the form. It will be things like name, address, contact number.

We will also require some tick boxes to questions on the form. The form will be one side of A4
Content on the front/back side and body: Header and information from cleint
Ideas for the visual style: does not need to be too fancy
Extra notes: I would like a form creating which i will use for my business. I will