Word doc file converted to Electronic version & uploaded to Website

I would like the attached document converted to an electronic template to upload to a new tab on our existing website. This form must become a template for data input by multiple users on each template. Once inputs have been made to each template it is to be saved into a library on the website. Once saved into the library it needs capability for users to access the saved form(s) to view and make further edits/inputs. The large white box to the top left hand corner of the document needs photos uploaded please ensure this is possible (preferably JPEGs without a size restriction?) Once the template is approved I would like you to create the tab on the existing website, please confirm if it is not possible to add to our existing website. I will confirm the website address upon awarding the project. Thank you