Simple Android Application

I have my own Android Developer Account. I need someone to create an application (specifics for the app are provided below) and then submit it to the Android Marketplace for my account. The application for this project is mostly just a simple form that users will fill out and submit, which will then send to my email address. I will create my own logo, so you do not need to worry about that. There will also be a link to my website in the app itself (simple enough). There will also be an initial disclaimer that the user will have to agree to in the app before submitting the form they fill out. I can give examples privately of similar applications that are out there that have what I want, but for the most part it is very simple. I want a user to be able to fill in variables (mostly like a typical "Contact Us" Form). It would be nice if it is easy to implement Google's tool that lets the user talk what it wants to be typed for one or two of the fields, but if that's very difficult, then we do not need it. I think this should take an experienced Android developer only 4-5 hours, at the most, and I can be in communication during the process to answer questions so it can be done fast and easy. All the details for submitting the application are already written. Thanks, Ben