Looking for a form to product pages

[Guest]

We are looking for a submit form that we can incorporate at the bottom of product pages which have a submit button sending the customer to checkout.

 

The form is to enable the customer to select a mobile phone model their network provider and a phone serial number which makes things easier for the customer to provide relevant information enabling us to unlock their mobile phone, which is the service they are purchasing.

 

I know we could ask them to write in the comments box within checkout but this is simply a blank box which is unprofessional and doesn't 'lead' the customer.

 

So if anyone can point to a contribution or write one for us we would be most greatful.

 

This is an example below of the kind of thing we require.