How to make a template of a ‘Request Form’

Hello there!
We would like to make a template of a 'Request Form' where anyone who would ask for help can just simply fill out the spaces describing the products such as its respective versions, operating systems, and plug-ins used.
We are also looking into the possibility of including an option for them to attach a snapshot of their product so that we could use it as reference while helping them.
Is there any way for us to do this? We are looking forward to your suggestions.
Thank you.
