Magento quotation field in static block

Hi, For one of our websites we use a static block in the right column where people can order their product. We used to use this with multiple order buttons and a static Magento ad to cart link but we need this to be dynamic now. So we want you to add the quantity field so people can choose how many they want to order. Attached you can find and example how it should look like. Only bid if you can do this very fast and can start directly!