Interactive rubber stamp for office

Good morning

I’m trying to built a digital rubber stamp wich will be applied to an Word 2007 document; the fact is that the stamp must have fields, some automatic (serial number increasing by 1, date and hour), as well some small boxes where people will interact (an “x” into a small box)… when that “x” is placed, that should automatically send a copy of the document by e-mail to the respective destinatary.
I already draw the form but can’t attach it to MS word (also would like to create a button on word in order to “stamp” that digital form). I tried using Visual Basic but achied a lot of problems.
Could anyone help me, please?
Thanks in advance

PS: English is not my native language, sorry for any errors