ts 0.3 requesting form

<div style="padding:25px 65px 15px; letter-spacing:1px; text-transform:uppercase; font:7px century gothic; color: #fff;"><div style="padding:3px;background-color: #079cd9;"></div><div style="background-color:#1f1f1f;line-height:10px; padding:15px 18px; text-align:justify">
<center><span style="font-size:11px; line-height:14px; color:#079cd9">R</span><span style="font-size:11px; line-height:14px;">EQUESTING</span></center> <div style="padding-top:4px">
► <b>Premade Title: </b> text here
<br>► <b>Your Title: </b> text here
<br>► <b>Author: </b> text here
<br>► <b>Subtitle*: </b> text here
<br>► <b>Mood/Genre: </b> text here
<br>► <b>Short Blurb: </b> text here
<br>► <b>Is your story posted: </b> text here
<br>► <b>Designer: </b> (please tag the designer so they can see the request)
<br>► <b>Anything else: </b> text here
</div></div><div style=" color:#079cd9; font-size:7px; text-align:center; border-top:2px solid #c9c7c7"> c.b. thefashionpixie </div>