create payment method for magento that collects and saves finance form data in orders table and displays in the admin section

We need to add a method of payment in Magento. This method will allow buyers to fill out a form for finance purposes and be called Finance. We will provide the fields for the form. It should be simple: name of bank, customer name, address, etc etc... The form has about twenty questions on it and all the answers should be saved in to the database. and displayed within the orders section with the admin panel Thanks, Citric Media