Create dynamic PDF with submit by email function

Hello, We're looking for a contractor to create a dynamic PDF (fillable PDF) with a function at the bottom to submit the PDF by email. Example: <[login to view URL]> (click on the link "Inscription pour un m?decin de famille" (sorry in french but you get the point). Our form is an 8 1/2 X 14 page with about 20-30 fields. So the user can fill it out then print it or submit it by email. If you have any questions please let me know! Roch