Personalized Poem Order FormPersonalized Poem Order FormPersonalized Poem Order FormPersonalized Poem Order Form

  

We will not share, trade, rent or sell any of the following information that you provide.
  

Format:                     Style:    

Occasion:     If Other, please specify:   

Who will it go to:    If Other, please specify:   

Name of recipient:        

Name of recipient's children, parents (whoever might be mentioned in the poem/rap)::
 

List some physical attributes of the person receiving the poem/rap:  ;
 

List some personality traits of the person receiving this poem/rap:  ;
 

Your Informationn
  Name
  E-Mail Address
  Company
  Street Address 1
  Street Address 2
  City State Zip Code
  Telephone Number (Optional)


Please select the desired length of poem/rap.  They are charged at 50¢/line..
Number of lines selected:  

Poems mailed by postal will be printed on 8 1/2 x 11 paper with an appropriate border.  Postal delivery requires an additional fee of $1.00.

How would you like the poem/rap to be delivered to the recipient?
E-Mail
Postal

Upon receipt of payment, your poem will be e-mailed to you for approval.
Please select method of payment.

Check
Money Order

Mail checks or money orders payable to: 
Concentrated Good Times
P.O.Box 132
Montchanin, DE 19710- 0132

Would you like the poem/rap to be delivered to yourself or the recipient??
Yourself
Recipient

If you want the poem/rap to be delivered to the recipient, please fill in his/her name and address or e-mail address:



Please provide detailed information about the occasion to allow us to personalize the poem/rap::

 

  
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