Hi,
I am interested in your project. I can create a web server suing python framework on linux machine. Using web server you can access a form and can send data to server using this form. I can do this in 1 day if get access to proper resource.
Below things are required to fulfill the requirement.
1. Linux/Unix system with SSH and internet access.
2. Python and flask
I can create setup by my self if linux system is available with ssh and internet available.
Please contact me for further discussion.
Thank you!