template.html

<style>
input{font-size: x-large;}
</style>

<img src="${input1}" /><br>
<input type="text" name="line1" size=60 /><br>

<img src="${input2}" /><br>
<input type="text" name="line2" size=60 /><br>

<img src="${input3}" /><br>
<input type="text" name="line3" size=60 /><br>

<img src="${input4}" /><br>
<input type="text" name="line4" size=60 /><br>

<img src="${input5}" /><br>
<input type="text" name="line5" size=60 /><br>

<img src="${input6}" /><br>
<input type="text" name="line6" size=60 /><br>

<img src="${input7}" /><br>
<input type="text" name="line7" size=60 /><br>

<img src="${input8}" /><br>
<input type="text" name="line8" size=60 /><br>

<img src="${input9}" /><br>
<input type="text" name="line9" size=60 /><br>

<img src="${input10}" /><br>
<input type="text" name="line10" size=60 /><br>