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Gordon Anderson
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Paul,

If your still looking for something like this, I can set you up a demo account with CollabAPI…

Basically its an App Builder tool to make these kind of form apps quickly, so you have the mobile app right away, and also a back end admin where you can see all the completed data.

Built in Melbourne and Bangkok… by a Kiwi.. guess were multinational, lol :)

cheers mate,

gord.