After a 2 sec google search, it looks like Image::Magick is what you may want to use. I am in the process of looking for some documentation.
EDIT: This is the best documentation i can find so far. Hope it helps :)

Also, at PDF::API2 it specifically tells you: 
# Add an external TTF font to the PDF
$font = $pdf->ttfont('/path/to/font.ttf');

[download]
So.. make a PDF, use the image, and then write whatever text on it you want on it after importing your font with the above method.
Also take a look at this link.

EDIT2: Would it not be just as easy (or easier) to just create an html page with the image as a background, and then align the user text input and format it however you want?

EDIT3: also GD looks to do this as well without needing to convert to PDF.

In reply to Re: Adding text to an image for printing by james28909
in thread Adding text to an image for printing by tel2

Title:
Use:  <p> text here (a paragraph) </p>
and:  <code> code here </code>
to format your post, it's "PerlMonks-approved HTML":


  • Posts are HTML formatted. Put <p> </p> tags around your paragraphs. Put <code> </code> tags around your code and data!
  • Titles consisting of a single word are discouraged, and in most cases are disallowed outright.
  • Read Where should I post X? if you're not absolutely sure you're posting in the right place.
  • Please read these before you post! —
  • Posts may use any of the Perl Monks Approved HTML tags:
    a, abbr, b, big, blockquote, br, caption, center, col, colgroup, dd, del, details, div, dl, dt, em, font, h1, h2, h3, h4, h5, h6, hr, i, ins, li, ol, p, pre, readmore, small, span, spoiler, strike, strong, sub, summary, sup, table, tbody, td, tfoot, th, thead, tr, tt, u, ul, wbr
  • You may need to use entities for some characters, as follows. (Exception: Within code tags, you can put the characters literally.)
            For:     Use:
    & &amp;
    < &lt;
    > &gt;
    [ &#91;
    ] &#93;
  • Link using PerlMonks shortcuts! What shortcuts can I use for linking?
  • See Writeup Formatting Tips and other pages linked from there for more info.