Create 2-page fillable pdf form

This is a two page form that we need to be able to post in a website, and have our customers download, fill in the blank and check boxes, and email the completed form back to us. We are providing a pdf that is non-fillable, and you create a fillable version. If there are any questions about what field we need to be fillable, or if there are any aesthetic layout issues, we will probably have one or two feedback rounds. The final pdf should be in a format that is editable by anyone with the proper software, and not locked or employing any proprietary software. We expect consistent and attractive layout, margins, line spacing, etc, much like the sample we provide. We will provide an oppoortunity to correct layout problems.