Single page data capture website

General information for the website: Single data
Kind of development: New website from scratch
Num. of web pages/modules: 1
Description of every page/module: I need a single page website creating that will be data capture form for a client. I want it building with Wordpress and Contact Form 7 so I can easily edit it going forward. There may be further pages to add.
Description of requirements/features: Fields for contact form

AGENCY DETAILS
Agency Name
Contact Name
Agency Office Address
Agency Contact Number(s)
Agency Contact Email

PROPERTY DETAILS
Address of property to be valued
Property type
Tenure
Age
Condition
Number of bedrooms
Number of receptions
Number of bathrooms

CURRENT OWNERS HISTORY OF PROPERTY
No of years at property
Original price paid
Changes made to the property since purchase
Other notes
Extra services needed: Installation
Extra notes: