Cover Form :: Icy Wonderland

<center><img src="http://i.imgur.com/9a8CcAn.png" width="400"><div style="background:ffffff;padding:20px 40px;text-transform:uppercase"><div style="background:ffffff;border-top:3px solid 6b92a9;border-bottom:3px solid c55d7e;padding:20px;font:9px arial; color:c55d7e;text-align:justify;letter-spacing:1px;line-height:9px"><div style="text-align:right;"><span style="color:6b92a9;"><b>Requesting A Cover</span></div><BR><B>
❄  Simple [] :: ❯ Manip [] :: ❯ Minimal []
<BR>❄  Title:
<BR>❄  Subtitle:
<BR>❄  Author:
<BR>❄  Summary:
<BR>❄  Genre:
<BR>❄  Mood/Color:
<BR>❄  Pictures:
<BR>❄  Ideas:
<BR>❄ Anything Else?
<BR>❄ Designer?