Help with new progran

[jay0]

Hi i am looking for someone to write a simple program for me that would allow me to print out a docket on a dot matrix.
I have posted on another forum too here is the link http://forum.codecall.net/request-services-paid/2255-help-program.html

[IMG]http://img120.imageshack.us/img120/166/jasonkeatleykr3.th.jpg[/IMG] here is what the docket looks like and here is some more information. If this is in the wrong forum I'm sorry can a mod please move it

Invoice To: alphanumeric/multiline
Delivery To: alphanumeric/multiline
Truck Reg: alphanumeric/ is it possible to have this as a drop down menu rather than having to type it in?
Dispatched by: alphanumeric/ is it possible to have this as a drop down menu rather than having to type it in?
Order No: alphanumeric
Account No: alphanumeric
Date: Date

<<Product Description>>
Quantity: alphanumeric
Grade/Mix: alphanumeric
Slump mm: alphanumeric
Cement Type: alphanumeric
Cement Content: alphanumeric
Aggregate Size: alphanumeric
Add Mixture: alphanumeric
Unit Price: Number
V.A.T. Rate: Number

<<Water>>
Water Added: alphanumeric
Slump: alphanumeric
Extra Water: alphanumeric
New Slump: alphanumeric
Signature for Water Added: Leave blank for hand-written

<<Time>>
Loaded: Date & Time
Arrived: Date & Time
Discharged: Date & Time
Departed: Date & Time

Signed: Leave blank for hand-written
V.A.T. No.: alphanumeric