Scanned Menu Redesign for Web(repost)

We have a scanned document of a shop's menu that we want writing out again for our website. Basically, we want a box next to each menu item so the user can print off the menu, tick the box and fax the order to us. It requires someone to type the whole menu out again. It's 2 pages worth. We want to clone the design of this page (changing the name,logo and telephone number to the one on our menu): <[login to view URL]> We want to be able to edit it too so don't publish it to pdf.