You can copy and paste the request form from here.

Email:
Name:
What you want to request: [psd, png, layout..etc.]
Images: [for psds or perhaps even the layouts if you want something specific]
Colors: [for layouts or blends]
Any other specific things:

***If you're requesting a psd/png and you want the picture to be editted in anyway, like lighting or maybe even color tone please note in "any other specific things".