Simpel wordpress 1 page!

I need a 1 wordpress page ONLY with upload form where customers can answer 3-5 questions and put them on the website so it become visable, i expect around 10.000 peopel to answer these questions. i have registrated domain name "[login to view URL]" It will be questions about "Sundsvallsbron" [login to view URL] , so i want the theme of the wordpress to make peopel understand it will be about this. You can also google this or look for pictures here: [login to view URL],or.r_cp.r_qf.&bvm=bv.52434380,d.bGE&biw=1540&bih=879&dpr=1.09&um=1&ie=UTF-8&hl=sv&tbm=isch&source=og&sa=N&tab=wi&ei=-tU7Upi1CK6P4gTouYBA