Singing Valentine Order Form
Singing Valentine Order form
Email address *
On what date do you want the Valentine? *
Choose which time window the Valentine can be delivered. *
Required
The individual's name receiving this Valentine? *
Your answer
What is the recipient's gender? *
How can we identify the recipient? *
Your answer
What is the street address to which the Valentine shall be delivered?
Your answer
What is the town or city? NOTE: The delivery must be within a 25 mile radius of Manhattan, Kansas.
Your answer
If helpful, what are the exact directions to get to the location of the Valentine recipient?
Your answer
What time would be the "perfect" time to deliver the Valentine (Note - we cannot guaranteed the time other than the window, but we will try to schedule accordingly) *
Time
:
Would you like notified in advance of the delivery? *
If you wanted to be contacted, please provide the telephone number to reach you.
Your answer
What message do you want us to put on the card?
Your answer
What email address shall we send a digital photo of the presentation?
Your answer
Who are you? In other words, who is ordering this Valentine? *
Your answer
If we have questions about your order, what is the best telephone number for us to call to talk to you? *
Your answer
If the presentation will take place in a restaurant, what is the telephone number of the restaurant?
Your answer
Thank you for your order. As soon as it has been reviewed at the Singing Valentine headquarters, you will receive an email message with instructions on how to pay for the Valentine using a credit/debit card or your PayPal account. For our information, please indicate how you heard about our Singing Valentine sales. Please check all that apply. Again, thank you.
Other:
Your answer
A copy of your responses will be emailed to the address you provided.
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