iPad App developer urgently needed

We are looking for a freelancer/contractor for a project to develop an iPad App. Our customer has several hundred books, which include fill-in-forms/checkboxes, etc. in them. The iPad application needs to give the user the ability to track information (that is, the user should be able to fill-in forms, checkboxes, etc.). If you have experience in iPad App development, we would like to talk to you. To qualify, please take the attached sample one page and provide an app that allows the user to check the boxes and fill in details in the table. You do NOT need to provide the source code to us. The app does not need to be exactly the same as the form provided. However, it should be close and allow the user to fill in information. The information entered by the user must be saved in the app. We will contact selected candidates for a full quote, with full specifications. Thank you.