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Deceased's full name (including maiden name, if known): *
Last city and state of deceased's residence:
Deceased's birthday or age: *
His or her nicknames for you:
Clubs or organizations he or she was a member of:
Date and place of death:
Special memories about this person:
List any other thoughts, facts, stories or memories you might wish to include in your memorial poetry:
Was this a religious person and do you want a spiritual emphasis? If so, describe this person's spiritual connection.
Your memories of special events in the life of this person:
Activities you enjoyed doing with this person:
Deceased's interests, hobbies and talents:
Anecdotal or humorous stories about this person:
Other people you would like to mention in this memorial poetry, if any:
What impact did this person have on your life and in what ways will he or she be missed?
Special events in this person's life:
Names, ages, and sexes of your fiancee's children, if applicable:
Did this person die unexpectedly?
Additional comments, notes or instructions that you would like our writers to consider in creating your memorial poetry: *
Important milestones in this person's life:
Describe your relationship with this person:
Special moments shared between you and this person:
If deceased was married, spouse's name:
Names, ages and sexes of deceased's children, if any:
Your relationship to
deceased: *
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: *
Your relationship to deceased (daughter, friend, co-worker, etc.): *
* Denotes required field
Physical traits of deceased (e.g., tall, short,
hair color, eye color, strong, handsome,
cute, intelligent, witty, talented, pretty etc.): *
Character traits of deceased (e.g., supportive, loving, kind, thoughtful, caring, hard worker, nurturing, unselfish, etc.): *
Cause of death:
Your nicknames for this person:
"special words for special people"
