I would like to create a form to be filled out that asks for

Customer Name

Account Number

Job #


Customer Contact Number

Desired Appt Date

Desired Time AM or PM

Rep Name and Location

Supervisor Name

I would like to be able to just fill out a form that asks these questions and than click copy, so I can easily paste the completed information. Preferably I would like it to display in a table with questions on left and answers on the right. I know that this is possible through HTML and maybe easier through Javascript. It has been years since I have tried to do something like this and I could really use some help.