So kid, ya want a banner?

Well, do ya? It don't matter what yer page is about. C'mon, they're free;ya ain't go nothin' ta lose! So please, fill out the form and I'll be getting that banner to ya real quick.
What's yer name, kid:

Email address:

What's the banner for?

Name of website:

Site address:

Any special text, slogans, quotes, etc?

Any other requests, like color, or a certain picture?

Do ya need it in a certain size?