banner form

<div style="color:666363;font-size:10px;font-family:consolas;padding:20px;text-align:justify;letter-spacing:2px;text-transform:uppercase"><div style="font-size:20px;text-align:center;color:404040">requesting banner<br><br></div>
regular or gif banner; [text here]<p>
title; [text here]<p>
author; [text here]<p>
ideas; [text here]<p>
at least two gifs; [text here]<p>
mood; [text here]<p>
genre; [text here]<p>
anything else; [text here]<p>