Cover Request

<div style="background-image:url(http://i.imgur.com/JGq6Twy.png);padding-top:215px;text-transform:uppercase;font-size:8px;letter-spacing:3px;color:fff">
<div style="padding:16px;line-height:9px;text-align:justify"><b>Cover Request</b><br>
<br>Title:
<br>Subtitle(optional):
<br>Author:
<br>Brief Summary:
<br>Celbrities(optional):
<br>Ideas(at least 2):
<br>Anything Else:
<br>Password:

</div>