Dusk Form

<center><img src="http://i.imgur.com/DXZC2Oy.png" width="410">
<div style="background-color:#ffffff;font-size:10px;font-family:'consolas';text-transform: uppercase;text-align:left;padding-right:15px;padding-left:15px;color:#000000;">
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<div style=" margin-left: 5px; margin-right: 5px; border: dotted #19070B 1px ;">
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<br><b>premade title:</b> text here
<br><b>your title:</b> text here
<br><b>author:</b> text here
<br><b>*subtitle:</b> text here
<br><b>*minimal changes?:</b> text here
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</div>
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