Freelancer:
SoneAF
PDF Form
Here is a JPEG of the PDF I have designed. Note I did not complete it 100%. Left just the payment section to finish. If you like this layout, I will happily finish it. Also note that this can be colored to your liking. I got the vibe you will be printing this so I didn't want to burn up colored ink. If you think you will end up doing on email or an on line PDF version. I can color this up and make it a fillable PDF for easy use. Feedback welcome.