Custom Verses - The Perfect Gift !


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curve.jpg (377 bytes) Information Collection Form
Thanks for your interest in a unique, personalized poem for a special need or occasion. Your poem will be a thoughtful gift with a truly personal dimension. You will always be remembered for choosing it!

To make this truly personal and memorable, please provide the information requested below. If you need something special which requires us to know something not on this sheet, include it, or call us and we'll talk it over. Or if you just don't like filling in forms and want to talk about your poem over the phone, just call.
Note: We cannot respond to or fill requests for delivery of any poem in less than two weeks. Please allow more time if possible.

Name:

Address:

Phone:

E-Mail:

IMPORTANT! When do you want this poem ready for giving?

Full name of person or group poem is to be written for or about:

From whom is this poem meant to be coming?

You yourself?
You and ?
A group or family? (Specify)
Some one or thing else? (Specify)

Occasion poem is to be written for (for example, marriage, birthday, anniversary, promotion, bar mitzvah, divorce, birth, vacation, graduation, etc.):

State in your own words what you'd like included in this poem. For example, the subject's age or date of birth, physical features; recalling of a special event or occasion; names of places, friends, associates, relatives; expressions of love, friendship, loyalty, etc; athletic, business or other achievements; hobbies, special tastes or personality traits; or anything else you want mentioned: (Be verbose. The more information you give us, the more personal your poem(s) will be.)

What type of poem do you want? Check those which apply:

Humorous: Serious: Passionate: Sarcastic:

Thoughtful/Reflective: Warm: Friendly: A "Roast":

Other (Specify):

Would you like this poem set to music? Specify a type, specific selection, tune or melody: