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Recipient's full name: *
City/state of recipient's current residence:
Recipient's age or date of birth: *
Is recipient related to you and if so, how?
Recipient's nicknames for you:
Your nicknames for the recipient:
Does the recipient have children or step-children?
What is the occasion for this poem and what message do you want to convey?
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry for this recipient:
Humorous or other stories or memories that that you would like to include:
Activities you enjoy doing with the recipient:
Recipient's interests, hobbies and talents:
Would you like this poem to have a religious or spiritual theme or include spiritual references? *
If not a family member, how do you know the recipient and list any details of your first meeting or history together:
Names, ages, and sexes of your fiancee's children, if applicable:
Names of recipient's children:
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
What, if anything, has the recipient done for you?
If married, spouse's name:
Your relationship to
poetry recipient: *
Your full name: *
Your mailing address: *
Daytime phone number and best time to call: *
Evening phone number and best time to call: *
Special instructions or comments and date poem is needed: *
* Denotes required field.
Provide us with the requested information about yourself.
Then complete the poetry information request form below as you are able. Remember, the more detailed the information you provide, the more personal and unique the gift.
Your email address: *
Is recipient married?
* Denotes required field
Recipient's physical traits (e.g., tall,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, etc.): *
Recipient's character traits (e.g., supportive, loving, kind, thoughtful, caring,
hard worker, nurturing, unselfish, etc.): *
List any special words or feelings that you would like to convey to the recipient:
"special words for special people"
