Hi! Here are few potentialy interesting design concepts for you! On entries #20 and #21 more simple design with cleaner forms, and on entries #22 and #23 more visualy elaborate option!
Hope you like them, and feel free to suggest improvements if felt needed! Thanks!
Regards, Bojan
P.S. Also, it would be advisable for you to check out this article about generic/overused designs, that is almost impossible to copyright/trademark protect: