Here's a possible option using the background package; the footer and header are placed as background material. Of course, depending on your actual settings, some dimensions will have to be adjusted:
\documentclass{article}
\usepackage{xcolor}
\usepackage{array}
\usepackage{fourier}
\usepackage{graphicx}
\usepackage{lipsum}
\definecolor{rulecolor}{RGB}{188,71,71}
\newcommand\fieldi{text1}
\newcommand\fieldii{text2}
\newcommand\fieldiii{text3}
\newcommand\fieldiv{text4}
\newcommand\fieldv{text5}
\newcommand\fieldvi{text6}
\newcommand\footertext{text text text}
\newcommand\ColRule{%
{\noindent\color{rulecolor}\rule{\textwidth}{1.5pt}}}
\newcommand\Header{%
\noindent\makebox[\textwidth][l]{\parbox{1.2\textwidth}{%
\hfill\includegraphics[height=2cm]{cc}}}\par\vskip1ex%
\ColRule\par\noindent
\begin{tabular*}{\textwidth}%
{@{}>{\raggedright}p{.25\textwidth}@{}>{\raggedright}p{.25\textwidth}@{}>{\raggedleft}p{.5\textwidth}@{}}
\fieldi & \fieldii & \fieldiii \tabularnewline
\fieldiv & \fieldv & \fieldvi \tabularnewline
\end{tabular*}\par\ColRule\par}
\newcommand\Footer[1]{%
\ColRule\par
\noindent\begin{tabular*}{\textwidth}{@{}>{\raggedright}p{\textwidth}@{}}
\footertext
\end{tabular*}\par\vskip-1.5ex\ColRule\par\centering\thepage\par}
\usepackage{background}
\SetBgColor{black}
\SetBgAngle{0}
\SetBgScale{1}
\SetBgOpacity{1}
\SetBgContents{%
\begin{tikzpicture}[remember picture,overlay]
\node at (0,0.6\textheight) {\parbox{\textwidth}{\Header}};
\node at (0,-0.55\textheight) {\parbox{\textwidth}{\Footer}};
\end{tikzpicture}
}
\pagestyle{empty}
\begin{document}
\lipsum[1-20]
\end{document}

The creative commons logo was taken from here.
And here's a solution using fancyhdr; as you can see, all the job was done with the definitions of \Header and \Footer; once these definitions are made, it is a matter of personal taste whether to follow the background or the fancyhdr approach:
\documentclass{article}
\usepackage[tmargin=1cm,bmargin=6cm,includehead,includefoot]{geometry}
\usepackage{xcolor}
\usepackage{array}
\usepackage{fourier}
\usepackage{graphicx}
\usepackage{lipsum}
\usepackage{fancyhdr}
\definecolor{rulecolor}{RGB}{188,71,71}
\newcommand\fieldi{text1}
\newcommand\fieldii{text2}
\newcommand\fieldiii{text3}
\newcommand\fieldiv{text4}
\newcommand\fieldv{text5}
\newcommand\fieldvi{text6}
\newcommand\footertext{text text text}
\newcommand\ColRule{%
{\noindent\color{rulecolor}\rule{\textwidth}{1.5pt}}}
\newcommand\Header{%
\noindent\makebox[\textwidth][l]{\parbox{1.2\textwidth}{%
\hfill\includegraphics[height=2cm]{cc}}}\par\vskip1ex%
\ColRule\par\noindent
\begin{tabular*}{\textwidth}%
{@{}>{\raggedright}p{.25\textwidth}@{}>{\raggedright}p{.25\textwidth}@{}>{\raggedleft}p{.5\textwidth}@{}}
\fieldi & \fieldii & \fieldiii \tabularnewline
\fieldiv & \fieldv & \fieldvi \tabularnewline
\end{tabular*}\par\ColRule\par}
\newcommand\Footer[1]{%
\ColRule\par
\noindent\begin{tabular*}{\textwidth}{@{}>{\raggedright}p{\textwidth}@{}}
\footertext
\end{tabular*}\par\vskip-1.5ex\ColRule\par\centering\thepage\par}
\fancyhf{}
\fancyhead[C]{\Header}
\fancyfoot[C]{\Footer}
\renewcommand{\headrulewidth}{0pt}
\setlength\headheight{107.4pt}
\pagestyle{fancy}
\begin{document}
\lipsum[1-20]
\end{document}
texdoc scrguien). They can do quite a lot out of the box. – Christoph Apr 3 '12 at 12:32