App for placing orders?????

I work at a church that records video and audio of each service and provides DVD/CD's to be available for pickup at a later date (once edited). Our current process for placing orders is a small booth with a stack of carbon-copy forms and we would just like to make it a little easier and more streamline for the church member.  Is there an app out there for the iPad that will allow me to create a form for a person to fill out and submit (to be emailed to me) so we could replace our carbon-copy forms?
Also, if there was a credit card payment option where they could swipe and pay (i currently use Square for photography gigs in my personal business) that would be amazing (but not necessary).
One final request... if this app exists, is there a way to lock the user into that app so they can't just start playing with the iPad?  We were thinking of building a nice looking case (podium of sorts) that sits in front of a larger LCD monitor utilizing the HDMI adapter mirror display for the iPad 2 but would also allow us to lock the iPad down and also maybe even hide the fact that they are even using an iPad... very ambitious i know and understand that I might need to hire a programmer...
Any suggestions would be GREATLY appreciated!

AWESOME! thanks so much!  the LocPad is EXACTLY what we need... the kiosk is almost there but not quite... check out this link to see more or less what we have and want in APP form... http://etcolumbus.org/#/media/media-orders
I guess we could actually just use LocPad to keep them on this page of the website huh?  it would definitely keep things simple...

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