Cover Form

hello you wonderful people! please copy and paste EVERYTHING below the line, thanksiessss!

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<img src="http://imgur.com/LBPyZVF.jpg" style="width:440px; margin-bottom: -45px;">
<div style="background: #ffdbe9; background-repeat: repeat; padding: 30px; color: ff48af; text-align: center; text-transform: uppercase;font-family: tahoma;margin-top:-135px; font-size:10px;">
<div style="padding-top:150px;">
<div style="padding: 5px 70px;">
<div style="background-color: ff48af; color: ffccda; text-align: center;">
</div></div>

I WOULD LIKE TO REQUEST A COVER.

TITLE:

AUTHOR:

SUBTITLE*:

GENRE:

IDEAS:

MOOD:

ANYTHING ELSE?*:

PASSWORD:

(* = OPTIONAL)