New User Request Form

We are currently in the process of migrating from our old helpdesk software to SD+. We have everything working except the following:

With our current system, if a requester needs to have, for example, a new user set up, he can then click on a link on the new request page that brings him to an html form to fill out detailing information about the new user (SEE ATTACHMENTS). This form would only be filled out when a new user needs to be added (obviously). The information that the requester provides is not really attached to the request, but is available in a separate database.

How can I either:

Insert a link to the form we are currently using on the New Request page
OR
Allow a requester to enter this information into a form entirely within SD+. I would only want these fields to be available when the new request involves a new user.