PERSONALIZED TUMBLR THEME REQUEST FORM

Name:
Gender:	Female Male
Email Address:
Tumblr Page URL:
Cellphone number:
Color Combinations (2-4 colors only):
Do you want an animated Tumblr theme?	Yes No
Text on the Banner/Header (Can be a quotation, numbers, names, etc.):
(Optional) URLs of the IMAGES/PICTURES that you want me to put on your banner:
Style/Theme (ex. Emo, Girly, Vintage, Love, Simple, etc.):
Do you want it to be transparent?	Yes No
Mode of Payment:	Globe AutoloadMax Globe GCASH