Please, I have found the two different codes, one for the page
[contact-form 3 "Contact form 1_copy"] which is almost perfect! just need to add two lines,
1. Persons name you are referring Instead of Subject
2. Are you a customer of Add A Link Of Charm Last order date approx please.
another one for a widget but not able to design, or I am not able to figure out how to do.