springs of color form

<div style="background:2D2E59;padding:6px 0;margin:0 40px"><div style="border-top:C00024 2px solid;border-bottom:C00024 2px  solid;background:2D2E59;padding:8px 30px;color:adadad;font-size:10px">
<b>PALETTE NAME*:</b> text
<br><b>COLORS WANTED:</b>  (or palettes you'd like to be remixed)
<br><b>WHAT YOU'LL BE USING IT FOR:</b>  (so that i know how quickly you need it)
<br><b>ANYTHING ELSE?:</b> text