da banner/blend form

<div style="padding:0 30px;margin:10px 0 -5px"><div style="background:F8F8F8;padding:65px 0 0"><div style="padding:5px 10px 0px;font:55px tnr;color:29A0E8;margin:-65px 0px 0px">●<div style="color:B8EA3A;font:50px tnr;margin:-20px">●</div<span style="color:A84FCE;font:45px tnr">●</span</div
<div style="font:18px century gothic;letter-spacing:1.5px;margin:-125px 0 0 30px;line-height:12px">DESIGNERS<div style="margin-left:-5px;">ARMY</div</div <div style="margin:0 6px 0 30px;padding:5px;font-size:10px;text-align:justify;line-height:10px"><b>requesting a <Span style="color:29A0E8;">banner or blend</span>;</b><div style="padding:0 5px 20px;">
Banner [] Blend []
<br><i>Title</i>
<br><i>Subtitle</i>
<br><i>Author</i>
<br><i>Summary</i>
<br><i>Ideas</i>
<br><i>Pictures</i>
<br><i>Mood/Theme</i>
<br><i>anything else?</i>
</div</div