Mobile sign up app

I need an iPad app. I would like it designed and built. That sign up app should be for iOS only I would like to create and sign up app for sales people that should have integration of a camera Along with freestanding Website for information only with just one page It’s for supermarket and drugstore Another word I will give this access to my sales person who will go in the field and sign up customers for our free delivery services so Customer will add up the data on the sign-up form and the the sales person we add there approval code for there Profile to be added for free delivery Must be able to receive pictures New customer sign-up page should look like 1- Full name first and last 2-Date of birth 3-Home address 5-phone number 6-Social Security number 7-Phone number 8-Insurance type 9-Phone number of Insurance 10-Hobbies 11-Approval code 12 Camera Icon to take photos to submit with form to admin as many as 3 13- submit Wait for the approval from the admin and then approved with the number or code And then after that there should be a pop up open that customer will get a gift with his first delivery a smart phone or equivalent device [login to view URL] Is it domain that I purchased through go daddy for this sales apps