Can we create Catalogs for Reconfigure Instance

Hi Team,

We have a requirement to integrate the reconfigure of instance with ServiceNow request so we have to create a form where we can give the below fields then we can create a policy for reconfigure and then attach the ServiceNow workflow

Name of Instance :
Start Date of the maintenance :
End Date of the maintenance :
Name of Cloud :

Please suggest because they are mandatory fields to pass.

Rakesh Gupta