Convert a paper form to a web form -- 2

Hi all. I have a form that reps are using out in the field right now. Currently, they are filling it out in the field and we are having to do double entry. We would like this form to be converted to a responsive web form that would render properly on all OS's and browsers. It would then e-mail to an appropriate e-mail address, and log the entries. We do need this form to have some sort of digital signature element, and this part is critical. I understand there will be questions and collaboration needed. We can host the form on our server. I look forward to good dialogue with bidders! I have included a sample of the form in question. If we are really satisfied with the work and we have a good solution, we have two more of these to do. Thank you!