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What is the occasion for this poem? *
Who is the subject of this poem (full name(s) please)? *
What theme, if any, is poem to be based on?
Short poem under specific picture or many pictures?
Describe the impact of this person(s) or occasion on your life:
Special names or nicknames by which you lovingly refer to this person(s):
Special memories you would like to include:
Tell us your feelings for this person(s) and/or thoughts about this occasion: *
Other people/names you would like to have mentioned in this poem and why:
Names, ages, and sexes of your fiancee's children, if applicable:
Funny stories/anecdotes you would like to include:
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
Relation of this person to you (child, parent, etc.): *
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: *
* Denotes required field
If you are mailing or emailing the photo, please tell us here:
"special words for special people"
