Valentine Order BTGO

Submit your info to order a uniquely yummy poem for Valentine's Day!

* Indicates required field

Your Name *

First

Last

Your Email *

POEM ONE SUBMISSION

Poem One Recipients First Name *

Untitled *

Recipients approximate age *

Untitled *

Gender *

Untitled *

What is their relation to you. (wife, boyfriend, grandmother, teacher, best friend, child etc.) *

The poem will indicate WHO the gift is from. What would you like it to say? Write exactly how you'd like it to read. ("Secret Admirer," "Your loving wife," "Love, Bob" etc... *

Please indicate any info you would like considered in the creation of this poem. For example: details, character traits, memories, nicknames, hobbies, interests, physical traits like eye or hair color, something you love about this person, how you met, how long you've known each other, do you have a special song or place you've visited together, or any theme or specific sentiment you would like expressed or explored. A specific memory? etc..etc... *

Any other special request? *

Is the poem being mailed back to you or directly to the recipient? *

To me To the recipient

How did you hear about this Valentines offer? *

Name and Address where you would like the poem to be sent *

Line 1

Line 2

City

State

Zip Code

Country

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