Hi how can i create an costum form like this

http://www.turistinfo.ro/mamaia/cazare-mamaia/pensiunea_h_briza-c84829.html

bottom ( Tarife valabile in perioada )
-is a form with period dates insert by me and user isert just (like a table :
1 , 2 , 3 , 4 , 5 , 6
Camera dubla matrimoniala
da
80 ron/zi
80 ron/zi
–
7 , 8 , 9 , 10 , 11 , 12 , 13
Garsoniera
da
120 ron/zi
120 ron/zi
–

and display in my post listing page when somebody post in specific categories?