DDG Icons/Banners Request Form

Name *
Please fill in your name. It can be fake or whatever, but do not leave it blank. Please remember to fill in your last name too. It can be faked, whatever.
Prefix
First *
Last *
Suffix
Email (*) (or website)
Fill in either the email or the website. Forms submitted without at least one of them will be ignored. Please make sure that your email/website is not faked and it really exists. Forms with faked emails/websites will be ignored. PLEASE fill this in so that we can contact you once your request is done.
URL (*) (or email)
Fill in either the email or the website. Forms submitted without at least one of them will be ignored. Please make sure that your email/website is not faked and it really exists. Forms with faked emails/websites will be ignored. PLEASE fill this in so that we can contact you once your request is done.
Theme *
Requests will be ignored if this is blank. You can request up to a maximum of 4 themes. And they will be divided accordingly to the quantity.
For example, if you request 4 themes and 40 icons, each theme will have 10 icons. Specify in the Others box if you need to.
Number of icons/banners
Fill in like this
e.g. 10 icons and 10 banners
e.g. 10 icons
e.g. 10 banners
If this field is not filled in, the number will be decided by us. A maximum of 50 icons and 20 banners only.
Do you want, *
 Icons only 
 Banners only  
 Both 
Please select one. If you don't we will ignore your whole request.
Due Date

DD
/
MM
/
YYYY
This is optional. But requests may not be done in time of your due date, sorry. But the latest it will come in is 3 weeks later.
The size (icons)
 100x100  
 300x300  
 No icons requested 
Select one. :D
The size (banners)
 400x195 
 400x150 
 375x150 
 No banners requested 
Seleeeeect!!! :)
Maker
If nothing is selected, whoever is free will do it. Sorry, Nayo will not be doing requests as she is going on a hiatus. Sorry for the inconvenience caused. Other makers are awesome too!
Others:
Anything else? Any specifications?
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