This cannot be done in Acrobat. You can try the LiveCycle forum to see if it is possible using LiveCycle Designer. If it is not possible in LiveCycle Designer, then it is possible in FileMaker Pro to distribute forms you would need either File Maker Pro Advanced (to distribute executables) or you might be able to do this on a server with FileMaker Pro or FileMaker Pro Server.
I could create text fields for Address and Customer Information in Acrobat pro. Customer can add relevenat info and save in these fields. For uploading images I believe there is something called adding Digital Signature which I am trying to learn how to add.