Traffic Ticketing Database Online Intranet

I'm looking to have an online intranet setup where employees will login from each office/store, and submit traffic ticket requests. On the front end side, the employee would fill out common field such as customer's name, address, court date, ticket number, ticket charge, and Jurisdiction, etc. On the Jurisdiction it would be a drop down menu with predined fields they can choose from. Once they click the submit button it will get stored to an database (MySQL or SQL Server). Another option I want to have is on the front end, there will be a lot of times when a client will come in and might have 3-4 different citation charges. Well the employee would need to be able to select each citation code and it will tell them the amount to charge the client. I will have a list of all the citation code and price. At the main office headquarters, I want a realtime dashboard so as new tickets are submitted, the employees at the main office will see them. The employees will have specific tasks to do for each ticket. Example task 1 would be Welcome Letter to Client Sent. I envision they check this box Welcome Letter to Client sent it would then prompt them enter in the Date/Time they sent the letter and select from a drop down menu which attorney they talked to. There will be other tasks assigned that I can go into more detail. All the letters and documents will be scanned locally to the employees scan folder on their computer and I want the abilty to upload those documents to each corresponding ticket. So when an employee clicks on a specific ticket, there would be hyperlinks example to open the Signed Retainer, or Citation, etc. For reporting I want to be able to run a report by date range and office/store which would break down how many tickets they processed that day, and the total amount of money so when they send the runner to each store they know exactly how many ticket and dollar amount to collect. For administration, example adding new items to the drop down menu, Jurisdictions, and Citation Codes and Charges, I want a GUI so the employee at the main office can update it themselves. For username and security. Each office/store will only have the abilty to enter in and submit tickets. They will not have access to the database or live databoard. The users at the main office will be the only ones who can access the dashboard and process the tickets. I plan on using a hosted server solution which I'm currently looking at different options, I would like your recommendations if you've used existing companies for this service. One last thing to note is I need this project completed no later then December 31st because where gonna go live on January 2nd, 2014. Of course I would like to have a working version a week before, so we can test everything out to ensure it's working the way it's suppose to.