Mobile Web Form

I have a simple form (see below) that I can provide an URL for my client to complete the form and submit. The Submitted result will be email to an email address as well as store a MySQL DB that I can view via an Admin area via PC. Need Clean and easy form that allow user to enter data via smart phone. If possible create an icon that my client can install in his phone and when click will go directly to the form. Title: Job Request Date: [Get Today's Date] Time: [Get Time] Job ID: [Auto generated Unique Number started with 5000] Job: [Drop Down - "Drop down list", ] Estimated Area: [Text Area Cols=15 Rows=10] Additional Descriptions: [Text Area Cols=15 Rows=10] Location: Company: [Text Field - size=15] Address: [Text Field - size=15] [Text Field - size=15] City: [Text Field - size=15] State: [Drop Down - KS, MO, NE, OK] Zip: [Text Field - size=15] Contact Name: [Text Field - size=15] Phone: [Text Field - size=15] Estimated Job Cost: [Text Field - size=15] Authorized by: [Text Field - size=15] By submitting this job request, I hereby authorize UBM to perform above job and agreed to pay the amount stated above upon completion of the job by UBM. [Submit]