Redesign form in a stylish and corporate format

I want the file attached below to be redesigned in a way that will make it look stylish, and corporate like a BILLION DOLLAR COMPANY form. The output file you'd submit has to be in Microsoft word. You can use the attached logo file where necessary. PLEASE NOTE: I need to use this form urgently. Hence, I'd award the contest to the best designed form even before the end of the contest, if I see something that I really like.