icon form

<p><center><img src="http://i.imgur.com/DIygTwr.jpg" style="width:440px" title="c.b. sta"></center>
<div style="background:000;margin-top:-10px;margin-left:1px;padding:30px 60px;font:7px arial; color:fff;text-align:justify;letter-spacing:1px;line-height:9px;text-transform:uppercase">
<b><u>ICON</b></u><br>
<br><b>SIMPLE [ ] MANIP [ ]</b>
<br><b>IDEAS/MODELS/THEME:</b>
<br><b>COLOURS*:</b>
<br><b>ANYTHING ELSE:</b>


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