Samsung tablet 3 form app

Hi, I need an app for the samsung tablet 3. Its basically a splash page with an animation and a 'start button'. Once the start button is pressed. We see a few screens to enter information. (1. splash) 2. enter name 3. Enter country (with autocomplete) 4. Select Gender (male/female) 5. Enter email address 6. Thank you screen. After 5 seconds, the screen goes back to the splash screen. When people reach screen 6, 2 emails are sent. One to the client and one to the admin. That's it. Another programmer tried but couldnt complete this. So i don't have a lot of budget, but there is another app after this which is much bigger. Please bid to complete this as soon as possible (hopefully today). I hope to hear from you soon. Best,