Valentine Poem Order Form

Name or Nickname:
Email that you use (response required!):
Address/phone or seconday contact
(Cybertown nickname or another e-mail):
Check the information you you wish to have considered for your poem!:

Emotion Warm True love humorous just friends
Who is the poem for? Mom, Dad, wife, husband, etc. The more specific you are, the more personal your poem will be! :
Mom Dad Wife husband boyfriend girlfriend male friend female friend
People Details:
Give us one taste to work with (one of each please!) :TASTE
sweet sour bitter spicy enticing addicting
Favor Details:
Give us one color to work with (one of each please!) :COLOR
black white blue green yellow orange red
Color Details/shades:
Give us one sound to work with (one of each please!) :SOUND
quiet music gentle background noisy loud
Sound Details:
Give us one smell to work with (one of each please!) :SMELL
sweet overwheming bitter spicy enticing addicting
Smell Details:
Additional Details or Comments