A mobile app that sends information via email

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

Project Description:
I am an insurance agent that works with several mortgage lenders and Realtor. I would like an app that the mortgage lender or Realtor can use to request a quote for their client.

1. Would need a one time set up screen for Realtor/Mortgage lender to put in their information
2. Need a client info tab. The required info is Name, Date of birth and physical address. Other info would be great but those three things are required.
3. After being submitted would need the info sent via email to my inbox.
4. Would also need a auto return email that confirmed submission.

Skills required:
Android, iPhone, Mobile Phone
About the employer:
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