A showcase of super-polite Japanese. 御 (ご/お) is the honorific prefix elevating the listener's belongings — 御名前, 御住所, 御電話番号. ~させていただく is the hyper-humble causative-receipt frame: literally 'receive the favor of being allowed to do X,' idiomatically 'would it be OK if I...?' The potential ~ただけますか adds 'would you be able to...?' The whole ending is a mountain of polite markers for what's essentially 'can I write this down?'