Appcelerator Titanium form for iOS and Android

I have a mobile app developer by Appcelerator Titanium, I need help in some form, the form is for reporting a complaint, the user fill all the information and select his location on the map and submit the form which send the data to online web service and return back a reference number to the user. the form is already developed, I need help in 2 things 1- send the data to the webservice and display the reference number to the user 2- adding button to open camera roll and attach photo the same service is running on the website on the following URL [login to view URL] so what I need is the mobile version of it. the data should be posted to the following URL [login to view URL] with the following variables: claimantType ClmDsc clmSite clmSubj latitude longitude persName siteCode regNo phone mobile userClmNo clmStatus siteName the form is attached here, please try it on your own and let me know if you can do it, the max. accepted bid is $100 again the form should work on iPhone and Android, I have both apps