Create a New Client Application Form based on my sample

I need a .doc or .xls version of this exact customer registration form that I have scanned a copy of. It has a front and a back. ## Deliverables 1) All deliverables will be considered "work made for hire" under U.S. Copyright law. Employer will receive exclusive and complete copyrights to all work purchased. (No 3rd party components unless all copyright ramifications are explained AND AGREED TO by the employer on the site per the worker's Worker Legal Agreement). ## Platform word, excel, windows.