Custom app for iPone & Android

The app allows users to fill out a table-like form having which has 4 columns and ability to add rows as needed.

Now the tricky part is that we need this form to treat one of the columns differently than the rest of the data collected. The data from 1 of the columns is sent once the form's "submit" button is pressed. The remaining information gets fed into a pdf which has a signature line. Once the pfd is signed, it is then emailed as an attachment.

Please give me an estimate on how much you could get this done for.

Thank you guys!