Can we create a form like page using VB Studio, any response in the form should store the value

Summary:

We have requirement to create a custom page using VB Studio and the custom page should look like a form, where it should take input from the user and once user clicks the submit button it should save the data in some fusion table.

Content (please ensure you mask any confidential information):

We have requirement to create a custom page using VB Studio. As shown in the below screenshot, the custom page should look like a form, where it should take input from the user and once user clicks the submit button it should save the data in some fusion table/custom table. so that later point we wanted to make use of that submitted data in the BIP reporting.