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 Phone Number:
What form do you want the poem in?
Clear selection
Receiver's name:
Receiver's email:
Receiver's address: (if selected greeting card)
City, State, Zip Code
1. How may I contact you if I have questions?
2. How do you want the Receiver's name on the poem?
3. How do you know the Receiver?
4. What is the occasion for the poem?
5. What are some memorable moments with the Receiver? (Give as many details as you can)
6. How does the Receiver make you feel?
7. How do you want your name at the bottom of the poem?
8. What is the Gender of the Receiver
9. What is the mood of the poem (Example: Serious, Humorous, combination)
10. How would you like to close the poem? (Example: I love you, Forever yours, Congratulations, ect)
Is there anything else you would like to include in the poem?
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