Chapter Banner Form

<div style="background-image:url(http://i.imgur.com/fFPvm6j.jpg);padding-top:50px"> <div style="color:b85d50;padding: 2px 24px 2px 35px;font-size:10px;text-transform:uppercase;letter-spacing:1.5px;line-height:9px;font-family:consolas"><center><b>Chapter Banner</b></center><p>
<p>Book Title (Optional):
</p>
<p>Chapter Number:
</p>
<p>Images/GIFs:
</p>
<p>Audio:
</p>
<p>Ideas:
</p>
<p>Other:
</p>
</p>