banner form (LOST BOY)

<p><center><img src="http://i.imgur.com/0ciXqLZ.jpg" style="width:440px" title="c.b. sta"></center>
<div style="margin:-5px 40px 0px 39px;padding:25px;border:1.7px solid e1e1e1;font:7px arial; color:C0C0C0;text-align:justify;letter-spacing:1px;line-height:10px;text-transform:uppercase"><span style="color:fba897">BANNER</span><br>

<br><b>TITLE*:</b>
<br><b>TEXT:</b>
<br><b>MOOD:</b>
<br><b>IDEAS:</b>
<br><b>ANYTHING ELSE?:</b>

</div>