Question
Scripts for Dynamic Stamps

I've created a Stamp of the above image on our servers. I've found a script that I've placed so that the Date auto loads
when the stamp is chosen. What I don't know how to do is make it give me an option of typing a Name in the By:
location and have the option of choosing which box a checkmark goes into.
Any help would be greatly appreciated.
We are running Acrobat Pro Xi Windows 7 64bit