bayuh's icons ; form

copy and paste this form below, filling in the blanks.
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* = optional
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colour schemes can be found at the colourlovers website
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for 'the icon being used at' part of the form, i'd like to know where this icon is being displayed.
example ; wattpad, twitter, tumblr
this is needed so i can get you the best results c:
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<center>

<i>f o r m</i><p>

<b>text:*</b>
<br><b>colour scheme, mood :</b>
<br><b>ideas, celebrities, etc :</b>
<br><b>matching header? :</b>
<br><b>icon being used at:</b>