Customer Sign Up Form for Bento for Ipad Llus Data Vase

I DO NOT NEED AN App CREATED. I need a customer sign up form only created that will work with Bento. I need a developer to create a customer sign up form with database using a platform called Bento for IOS. Read about the app here [login to view URL] The customer sign up form will contain fields such as from title, Event type Name [first and last], zip code, type of pet [dog or cat], email phone number and must have company logo and similar theme to our website. Please include examples of work and my timeline is within 4 days.