Lead Form Builder Script or Software - READ!!

I need a lead form builder script/software similar to the following although with picture and video upload and playing capabilities, margin or size settings, buttons with links, and background images/text upload. I want to be able to copy and paste code after its created. Saving function is also nice. [login to view URL] [login to view URL] If you know of some already built and ready to use let me know. I do not pay monthly fees and I wont pay to build a new one.