wallpaper form (LOST BOY)

<p><center><img src="http://i.imgur.com/0ciXqLZ.jpg" style="width:440px" title="c.b. sta"></center>
<div style="margin:-5px 40px 0px 39px;padding:25px;border:1.7px solid e1e1e1;font:7px arial; color:C0C0C0;text-align:justify;letter-spacing:1px;line-height:10px;text-transform:uppercase"><span style="color:fba897">WALLPAPER</span><br>

<b> DESKTOP [ ] MOBILE [ ] PROFILE HEADER [ ]<br>
TEXT:*</b>
<br><b>IDEAS/THEMES:</b>
<br><b>SCREEN SIZE (FOR DESKTOP/MOBILE):</b>
<br><b>COLOUR PALETTE:*</b>
<br><b>ANYTHING ELSE:</b>

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