[MM3-users] Moderated Signup with "info" box?

Hi all, we have a mailman deployment that we are using for a private neighborhood community board. We have the list setup for moderated approval signup. The trouble is, when someone signs up, we only get a request with their email address. I would like to be able to use the web form, but have a "notes" field that would get submitted with the signup request. the notes field would be where the user would note name/home address. So when one of our moderators get the request, they can figure out quick who the request is coming from.

Can anyone provide some guidance or assistance on how to make that happen?