[Plugin] Form builder

Hi all, im after a form builder plugin which allows me to drop it in on a page and also allow me to line up images to the side of a field in the form. for example.. a picture of some shoes then a drop down box with sizes and then a quantity box, all lined up next to each other.

Im creating a order form basically, so it will need to email off to 2 different email address.

Hope that makes sense.

thanks