Form for joomla website(repost)

I need a form for joomla website the same as the one of attachment. Once the user will add necessary data in forms, in the bottom of the page will have a button to print out this form. The printing will be on A4 paper format, and will contain only form with no other website components. A will need also to know from where I can change the text form on the future. Please ask if have any questions. Thank you! ## Deliverables the website url where must be add this form is: [login to view URL]