Basic Portal / Zen Desk API integration

Hello, I'm looking for someone to help me create a Basic Portal with really basic information like Name Email address Telephone Number Address Details Start Date End Date Monthly Cost Notes Customer Notes I would like the port above to obtained from a webpage form asking : Name Email address Telephone Number Address Details Customer Notes Page 1 - Title / Content text / upto 5 photo's Page 2 - Title / Content text / upto 5 photo's Page 3 - etc.... upto Page 15 I would like them to hit the submit button and it add all this information to the above portal (not really bothered about pictures) and all information including pictures to be sent to zen desk api <[login to view URL]>