270400 Create HTML from scanned doc

This is a straightforward project - the attached PDF files are a 2-part scan of a physical document. I need a HTML version of this document that will be used for printing, after filling in the relevant data using PHP. This can be a simple table layout with blank spaces instead of the boxes for filling in by hand. I just don't have time to do it myself. Alternatively this could be created in Photoshop and cut into a table, as long as there are <td> sections to fill in the appropriate data. When printed along with the data, it should look as similar as possible to the original form. Does NOT have to be XHTML. Hopefully this makes sense! Thanks for your bids!