<h1>Request a banner form</h1>

Your Name/Nickname *
Your Email Address*
Size of Banner** *	800x200 pixels   700x200 pixels   600x300 pixels   Other?
Specify Image?*** *
Other Comments

Powered byEMF Free Form Builder

Report Abuse

*If you don't have an email address, no need to panic. Just leave this field blank. You will be able to pickup your request from the <a href="http://kasumi.netii.net/pickups.php">pickup station</a> as soon as it is finished.<p>

**If you choose the "Other" option, please specify the exact size you'd like your banner to be in the "Other Comments" box.</p><p>

***You can put the direct link here to an image you'd like me to use on the banner, or you could say an anime character/Pokemon's name here.</p>