How to create a fillable form without distribution information?

I'm looking to create an informational sheet (PDF) in which some of my offices can insert their own contact information into a single box. I want to get rid of the purple box on the top of the form which talks about distribution which will confuse many. Is it possible to create a plain PDF with one box to insert information into without all the fancy stuff to send the form back? I don't need to track it or get it back!
Thanks

Hi llvi56,
You might want to refer the KB : http://helpx.adobe.com/acrobat/kb/create-fillable-pdf-forms-acrobat.html

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