e-sign consent forms

Is there a template for E-sign consent forms that would the following:

The consent form should cover below requirements:

1. 1.Consumer should affirmatively consent to the use of electronic record to

provide information.

2.Consumer should have option to withdraw the consent and must be made aware

of the necessary procedure.

1. 3.Consumer should be informed of the right or option to have the record made

available on paper or in an non-electronic form.

4.Consumer should be provided with the hardware and software requirements to

access and to retain the electronic records.

1. 5.Consumer should be informed whether the consent applies only to the

particular transaction or for all transaction during the course of the

parties relationship.