Need a document put into html format and esignature capable- URGENT!

I currently have a custom lender software. And I have a paper loan contract that I need put into my software. The form will need to have blank fields in the appropriate areas to be filled out by a human (about 16 fields). Other fields on the form will need to "grab" the customers information from our database (7 fields)= (my software programmers will do this part at your instruction so you DON'T need to program this!). Then, in practical use after the form is filled out... it must be e signed by the customer and logged into our system (again, at your instruction, my programmers will code what you need). Also, this form (after esigned) must be able to be downloadable so the customer can get a copy. I hope I've explained the project ok... please ask questions if you need clarification. I have a SMALL budget for this, but I will need services like this in the near future on other projects so this is a "in". Thanks.