Please refer to this same form for covers, banners and icons. Simply ignore inapplicable details (eg: an icon won't, necessarily, have a genre or story title).
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Form

Type: (banner, cover, icon)
Author's Name: (as will appear on cover)
Story Title:
Sub-Text: (as will appear on cover)
Genre:
Cover Style: (Romantic, Contemporary, Vintage, Noir, Playful, Childlike, etc.)
Preferred Font(s): (end result may differ*)
Preferred Colour Scheme for Font(s): (specify colours, can be 1+)
Short Summary/Synopsis of Story:

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If you would like a main character to feature on your cover, please include a Cast or description of that character.

Thank you.