Create web Form: i have a list of fields about 40, i need a web form created

Hello All Dev's, I have a simple webform i need to create. i basically need a nicely laid out form that will email me the input. basic html page: nice looking: there are fields and selection items i need All Fields in the Detail Section: *Note the selection items here are some of the basic fields: <colgroup> <col /></colgroup> | Name: | | Address: | | ID Number: | | Rank: | | Select One: | | Active | | Retired | | Resigned | | If retired or resigned, please note the date of retirement or resignation: | | Highest Level of Education (select one): | | High School | | Associate's | | Bachelor's | | Master's | | Doctorate | ## Deliverables All Fields: <colgroup> <col /></colgroup> | Name: | | Address: | | ID Number: | | Rank: | | Select One: | | Active | | Retired | | Resigned | | If retired or resigned, please note the date of retirement or resignation: | | Highest Level of Education (select one): | | High School | | Associate's | | Bachelor's | | Master's | | Doctorate | | JD | | Mail Station: | | Assignment: | | Home Phone: | | Cell Phone: | | Personal E-mail Address (Non-PD): | | Veteran (Y or N): | | Branch of Service (If you have served in the military, please select one of the options): | | Army | | USAF | | USN | | USCG | | USMC | | Army National Guard | | Air National Guard | | Active Reserve (circle one): | | Army | | USAF | | USN | | USCG | | USMC | | Army National Guard | | Air National Guard | | Date of Birth: | | Date of Hire: | | Joined POA (date): | | Academy: | | Break in Service (if applicable): | | From: | | To: | | Blood Type: | | If another officer is in need of a bone marrow transplant, would you be willing to be tested to see if you could be a donor? (Y or N): | | Beneficiary: | | Relationship: | | Electronic Signature: | | Date: |