2
Sounds like you need the Liaise module.
You can make the form as simple or complicated as you like. There's an "example form that you can use/edit or you can make your own new one.
For the XOOPS 2.0.x branch use v1.26 from
here.
Works fine with XOOPS 2.0.18.1/php5
For the 2.2.x branch use v1.50 from
here.
Not tried this one personally.