WHMCS + KAYAKO Helpdesk: Create a custom page to take input from user and pass details to php file -- 2

Hello I want to create a custom page in WHMCS for support / ticket submission. Which will take input from user and will pass it to PHP File which automatically generates the ticket id. On page I want below details 1. List departments (Support / Sales / Billing / Migration) 2. List type of nature for each department (support/sales/billing/migration) 3. List of active services (User will select for which product he is facing issue) 4. Display box for where the customer will post his question 5. Pass user values to php code which is already ready and display ticket id on page. I have a php code that submits a ticket and generate the ticket id. Ticket ID generation code is already ready. You just need to pass values into that form/code/page. I also want to process whmcs product id and client id as the custom field/ which is already created in kayako. HTML code is ready for the pages.