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Name of person(s) leaving: *
City/state of recipient(s)'s current residence:
Is this person(s) a friend, relative, or co-worker? *
Is this person(s) a relative and if so, how?
Type of relationship you have with recipient(s):
Why is recipient(s) moving (employment, be close to family, job opportunity, etc.)?
Names, ages and sexes of recipient(s)'s children:
How will recipient(s)'s absence affect you?
List any other thoughts, facts, stories or memories you might wish to include in your gift of poetry for the recipient(s):
Stories or memories that would be important to this move:
Humorous stories of times shared with the recipient(s):
Do you plan to keep in touch with the recipient(s) and if so, how (mail, visits, etc.)?
Is this poem from an individual or a group and if group, names you want on the poem?
Anecdotal or humorous stories about the recipient(s):
Would you like this poetry to have a religious or spiritual theme?
What main sentiment do you want your poetry gift to convey (e.g. humorous, serious, loving, caring, or combination)?
Is recipient(s) moving out of state, out of country, etc. and if so, where?
Names, ages, and sexes of your fiancee's children, if applicable:
Recipient(s)'s occupation(s):
Additional comments, notes or instructions that you would like our writers to consider in creating your gift of poetry: *
Number of years you have known this recipient(s):
Do you want to acknowledge the importance of your relationship with the recipient(s) and if so, tell us about your relationship?
Special moments shared between you and the recipient(s):
Does the recipient(s) have children or step-children?
Your relationship to
poetry recipient: *
Your full name: *
Your mailing address: *
Daytime phone number and best time to call: *
Evening phone number and best time to call: *
Special instructions or comments and date poem is needed: *
* Denotes required field.
Provide us with the requested information about yourself.
Then complete the poetry information request form below as you are able. Remember, the more detailed the information you provide, the more personal and unique the gift.
Your email address: *
Is the recipient(s) married?
* Denotes required field
Recipient(s)'s physical traits (e.g., tall,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, etc.):
Recipient(s)'s character traits (e.g., supportive, loving, kind, thoughtful, caring,
hard worker, nurturing, unselfish, etc.): *
"special words for special people"
