Create Editable PDF Customer Enquiry forms using our Style Guide

I would like to create a double sided client enquiry form. I have hand written the criteria of what I am chasing and have an example of a previous once I had created at another company I worked at. I have a style guide with Logo and colour pallette required for your direction and I would prefer the document to be set up as an editable PDF where the fields of selection can be check boxed for emailing to a client online. On the form I have hand written; the red dashes signify spaces between options and the highlighted sections are to be headlines. There would need to be a Field on the bottom of the second page with 4 lines that can be edited for Name, Job Title, Phone Number & Email address as per example document. I am open to ideas on the overall finish of the form but need something that is easy to use and can be printed on white paper primarily. Any further questions please let me know.