Create template for data entry

I am looking for someone who can create a template for me so i can enter data on that. This should be done so i can adjust things after the work is done too The data that is entered should be made so i could copy it with 1 click to I could paste that on a notepad. The date should be separated nicely when pasted. Data should be saved to so i can access it. I also want to look up data on the hand of a few things date/customer number/Case Number The form should have premade text boxes I have an example of how it should look. Tell me with what program you would create this, when you can finish this and how i can edit it