1 page, 7 fields form filling page/app for tablet, for customers to leave their info

General information for the website: we hire out table linen
Kind of development: Customization of existing website
Num. of web pages/modules: 1
Description of requirements/features: Hi there,

Sorry I'm not much of a techie so excuse me for the way I try in describing what I need.

Im looking for someone to make me an app/page for a tablet where a customer can fill in personal details (on my ipad).

I'd like to be in a position where I can just hand my Ipad over and they fill in 5-6 fields and put in their personal details and just click submit.

- Nothing extravagant, just a simple form.
- does this need to be web enabled/ or can this work offline ?.
- I already have a website, does this need to be linked or can it be independent of this ?
- I'd like it to be in my colour scheme, font and have my logo somewhere.
- once a customer has filled out a form and clicks submit, where does this information go ? to my email ? stored on the ipad ? to a cloud ?
- Will this be one time life long ? I don't want to pay monthly in anyway.
- prefer to work with somebody in UK, (perhaps close to London, Surrey, Berkshire, Buckinghamshire)



-Form field required-

1. First name (blank)
2. Surname (blank)
3. Contact Number (blank)
4. Email (blank)
5. Event day - (could be in drop down, day, month, year)
6. Expected number of guest (dropdown/scroller dial 0-49, 50-99, 100-149, 150-199, 200-249, 300-349, 350-399, 400-449, 450-499, 500+)
7. Short listed venue or area (blank)

SUBMIT BUTTON.

Thanks
Extra notes: As this is a small and simple task I am only looking for a very reasonable quote, prefer quotes from new tech guys - non expert level. Budget is small, If you fancy it please contact me thanks.