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Nicknames or petnames for him or her:
Was he or she a Godly person and if so, how? *
Cause and circumstances of death:
Date and place of death:
How do you want this person to be remembered?
Deceased's full name: *
City and state of deceased's residence:
Deceased's birthday or age:
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry about this person:
Deceased's relationship to you:
Humorous stories or memories about or with this person that brought laughter to you or others:
Memories of special events that stand out in your mind or events you enjoyed together:
Activities he or she enjoyed doing or things you enjoyed doing together:
Nicknames or petnames for him or her:
Was he or she a Godly person and if so, how? *
Future plans to honor this person's life, if any:
Cause and circumstances of death:
Was he or she a member of any club or organization? If so, which one(s) and for how long?
Date and place of death:
How do you want this person to be remembered?
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry about this person:
Do you want this poem to be a serious tribute or one that combines fond memories with humorous anecdote? *
Humorous stories or memories about or with this person that brought laughter to you or others:
Are there words of comfort this person used that might bring comfort to others today?
Why or what things about this person will be dearly missed?
Memories of special events that stand out in your mind or events you enjoyed together:
Names, ages, and sexes of your fiancee's children, if applicable:
Individual(s) most significant in deceased's life:
Activities he or she enjoyed doing or things you enjoyed doing together:
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
Acts of kindness that you remember most:
Future plans to honor this person's life, if any:
Describe his or her main focus in life:
Special moments shared between you and this person:
Any pets that touched his or her life:
Was he or she a member of any club or organization? If so, which one(s) and for how long?
Hobbies he or she enjoyed:
Your relationship to
poetry recipient: *
Do you want this poem to be a serious tribute or one that combines fond memories with humorous anecdote? *
Are there words of comfort this person used that might bring comfort to others today?
Why or what things about this person will be dearly missed?
Names, ages, and sexes of your fiancee's children, if applicable:
Individual(s) most significant in deceased's life:
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
Acts of kindness that you remember most:
Describe his or her main focus in life:
Special moments shared between you and this person:
Any pets that touched his or her life:
Hobbies he or she enjoyed:
Your full name: *
Your mailing address: *
Your relationship to
poetry recipient: *
Daytime phone number and best time to call: *
Evening phone number and best time to call: *
Your full name: *
* Denotes required field.
Your mailing address: *
Daytime phone number and best time to call: *
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: *
Evening phone number and best time to call: *
Special instructions or comments and date poem is needed: *
* Denotes required field.
Names of surviving spouses, siblings, and/or children:
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: *
Names of surviving spouses, siblings, and/or children:
* Denotes required field
Physical traits of deceased (e.g., tall,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, etc.): *
Character traits of deceased (e.g., supportive, loving, kind, thoughtful, caring,
hard worker, nurturing, unselfish, etc.): *
* Denotes required field
Physical traits of deceased (e.g., tall,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, etc.):
Character traits of deceased (e.g., supportive, loving)
hard worker, nurturing, unselfish,
"special words for special people"
