Convert PDF document to HTML Form

I need a 3 page PDF document converted to an HTML Form. The HTML version of the document that you create needs to be formatted exactly as the PDF with the following exceptions. * Any tick boxes need to be a Form Checkbox * You will be creating a template of this PDF as HTML so that I can push data in to the HTML document where required. * Every aspect of the HTML version needs to be HTML or CSS. No images can be used. * You can use DIVS or TABLES I don't mind but the end product must print exactly on 3 pages from within Safari and Internet Explorer 9.