325736 Small form in VB or Access2003

I have a small MSAccess 2003 Database, having a single table need a simple search form preferrably created in Access itself to show all fields of records by submitting the search, the search basically consist of 5 drop downs (showing distinct values from respective fields) and a text box can have any value(s) seperated by comma to search through the database. form shd exactly look like as the power point file attached.