Blank HTML Packing Slip Page Design

I need an html page page that conforms to the attached image specs.

I need place holders in the following spots. Something like "CONTENT HERE" or something obvious.

The small square in the top left

The open space in the top right (an image will be here)

The big spot underneath the perforation.

Everything must be coded onto a single html page (no css files). I'll need to test it for conversion to pdf/printing prior to payment.

CSS HTML

Nº del proyecto: #4912380

Sobre el proyecto