Reservation Form Application wrapped with PhoneGap - repost

Avg Bid (USD)
Project Budget (USD)
$30 - $250

Project Description:
Looking for Help designing a form that a user fills out to request service that can be wrapped using PhoneGap and submitted into the App Stores. Will need help in submitting to the Android Marketplace. User cannot submit form unless connected to some data (wifi/data plan). The form will need to work when wrapped in PhoneGap. Form has some required fields. Form is already built. Looking for something very quick and easy to be built. It can be PHP form if PhoneGap/Android/iPhone will support it.

Skills required:
Android, iPhone, jQuery / Prototype, Mobile Phone, PhoneGap
About the employer:
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