Very Simple Android App needed

I need a simple android application written that will allow someone or a business who is accepting cash transactions to send the person a receipt via text or email. The app should have a few fields: Field 1: Name Field 2: Receipt Number (user entered) Field 3: Details (add up to 6 entries) Field 4: Amount Field 5: Cell Phone Number Field 6: Email Address Field 7: Ask if we can put them or mailing list for free offers. Field 8: Image Upload (for signature or actual reciept) I need the following capabilities: Should have the option to send via email OR cell phone number. Should have the ability to store all cell numbers and email addresses to a database. Should have the ability to post receipt to my website using a random ID. App will send the image of the receipt along with the text. Members Section so users can view and store their reciepts.. download them if necessary to CSV. The members section can be very basic, as long as I can design the html around it...