Change PDF document to editable word document (or other format)

I have one page PDF document (an order form with multiple fields and tick boxes) that would need to be changed into a Word document so people can amend the order form and send it back to us filled in. If you can suggest other format than Word please do. Basically this form will be up on internet and sent to people who want to our product and therefore needs to be in a format that they can easily fill in/amend and then email it back to us. Current PDF document is branded with corporate logo and colours etc and the word document would still need to look 'corporate' following the same font and design as much as possible as is on the PDF. I understand there are limitations as to what can be done on Word but the key is that the final document would still need to look as professional and 'on brand' as possible. Attached is the PDF(its not 100% final yet) - its missing the logo from the top which will be supplied.