Need a form converted to webpage and allowing e-signatures with mouse, then output to PDF file and reset form.

I need a petition converted to an online form that I can put on my WordPress website that will allow 12 people per form to enter their name, address, and birthday and then allow them to e-sign using their mouse. After 12 signatures, the form would need to automatically be converted to a word or PDF document in 8.5"x14" legal size and be emailed to my email address or somehow saved. The form fields would then be cleared to allow 12 more people to sign. this would repeat indefinitely. This is EXTREMELY time sensitive and would need to be completed as quickly as possible. preferably no more than 3-4 days.