Questionnaire For Ordering a Poem

Please complete all sections of this form so we may provide you the best possible service in a timely manner.  Any information missing will need to be verified by phone which delays the time to send you your poem.  Thank You,

Your Name:

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Best Way to Contact You:     Day Phone   E-Mail:   Evening Phone:

Best Way to Receive Your Draft? Day Phone   E-Mail:   Evening Phone:

Occasion or Event:   (select one)  

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Name of Person(s) Poem is For:

Location of Event (if applicable)


Your Thoughts of Event/Occasion:
 

 

Something Special About the Person(s):

 

Special Interests of Person(s):

 

How Does He/She Make You Feel?

 

What Was The First Attraction to This Person?

 

Additional Comments:

 

 

Your order will be processed once payment has been received.

Thank you for your interest in Gifts From My Heart,

 

 

 
 

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