How to create custom form and theme?
This is more of a hint since I don't have "comment" privileges yet. 
You could create 4 field sets to accommodate the rows. Then create the collected funds and donor fields and when you add fields in each field set, use the respective field rather than create new ones. 

So you are then left with html that you can very easily manipulate into having the appearance of being a table. 

You would need to position the fieldset label to the left rather than on top and then hide the field labels for all but the first field set (giving it an absolute position and setting the first field to have enough left margin should accommodate this. 

Then position the fields by either setting max widths and floating left to keep it responsive or setting the width of the field and the fieldset so that it's not responsive.