Custom form for shopify

We have a furniture page on shopify and want customers to be able to choose 5 swatches that they can request and we can send them out for free. We have up to 40 fabrics that a customer can choose. It is a form that customer will fill in their details such as name, address, city, town and postcode etc and choose 5 fabrics. The fabrics will need to be shown with images.

https://www.bijouxliving.com/order-free-swatches/ - for refrence purposes