Customized Poem Questionnaire
If you would like to buy a customized poem, please fill in the Questionnaire below. When I receive your answers and payment, I’ll begin making your poem. For the best poem possible, the more details I can receive from you the better. I’m looking forward to creating a poem for that special person in your life.
Email address *
Your Name: *
Your answer
Your Phone Number:
Your answer
What form do you want the poem in?
Receiver's name:
Your answer
Receiver's email:
Your answer
Receiver's address: (if selected greeting card)
Your answer
City, State, Zip Code
Your answer
1. How may I contact you if I have questions?
Your answer
2. How do you want the Receiver's name on the poem?
Your answer
3. How do you know the Receiver?
Your answer
4. What is the occasion for the poem?
Your answer
5. What are some memorable moments with the Receiver? (Give as many details as you can)
Your answer
6. How does the Receiver make you feel?
Your answer
7. How do you want your name at the bottom of the poem?
Your answer
8. What is the Gender of the Receiver
Your answer
9. What is the mood of the poem (Example: Serious, Humorous, combination)
Your answer
10. How would you like to close the poem? (Example: I love you, Forever yours, Congratulations, ect)
Your answer
Is there anything else you would like to include in the poem?
Your answer
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