i want to add a configuration form for a block.the form's style is as belowing

one year (label)            input text box value    eg:$10     
two years            input text box value     
three years          input text box   
500 accounts         input text box   
1500 accounts        input text box   
2500 accounts       input text box   
image:              can upload an image

how do i do? i should write a module to get that.

1, how do i design the table, which used to store the input box value and image value.eg: the table is example. how to design the fields? thank you.

2,which hook i should use?