Need to send a GPS location & phone to a specific business ask if you need more detai

General information for the app: this app gets me help after an accident by pressing one image.
Num. of web pages/modules: one module
Description of every page/module: Broken down, accident, need help now? Press this button and get help at no cost to you. We will call you back, and will notify your insurance, send a tow, and a rental, or medic if you need one. plus we will notify a person of your choice about your situation. One page and one button, nothing fancy.
Description of requirements/features: As above. I call it panic button.
Specific technologies required: must send GPS location, and cell to specific business
Extra notes: I need an app. to. send GPS & cell phone to a specific business, asking for a call back ASAP (I AM BROKE DOWN, OR INVOLVED IN AN ACCIDENT)

I have an app. But it is not specific. So I need a custom app.