Create quick order form at product page

I have created a quick order button using following code at /app/design/frontend/Smartwave/porto/Magento_Catalog/templates/product/view/addtocart.phtml.

But, when popup modal opens then I need to show form with the following detail:

1. Full Name
2. Mobile Number
3. Address
4. email (optional)
5. Customer Note (optional)
6. quantity
   and email above detail to admin with product page URL

<button type="button" class="action primary" data-trigger="trigger">
    <span data-bind="i18n: 'Quick Order'"></span>
</button>
<div data-bind="mageInit: {
        'Magento_Ui/js/modal/modal':{
            'type': 'popup',
            'title': 'Popup title',
            'trigger': '[data-trigger=trigger]',
            'responsive': true,
            'buttons': [{
                text: 'Place Order',
                class: 'action'
            }]
        }}">
    <div class="content">
        Popup Content
    </div>
</div>

<div class="actions">
    <button type="submit"
            title="<?php /* @escapeNotVerified */ echo $buttonTitle ?>"
            class="action primary tocart"
            id="product-addtocart-button">
        <span><?php /* @escapeNotVerified */ echo $buttonTitle ?></span>
    </button>

Example website of quick order button is: https://www.shophive.com/huawei-y7-prime-2019-3gb-64gb-red