form like delta on facebook.com

We want to have an form in facebook. Like [login to view URL] The form is activated after a click. The form is on a different server. The form should be prefilled with data of the person who is logged in in facebook. Then the person has to add some information and the data is send. We have the source form. WE only need to integrate it into facebook. No design is needed. IN order to prevent Spam please put the word "Twitter" in your reply so i know you read the request.