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Keepsake Family Poems

Keepsake Family Poems Order Form


All items marked with a "*" are mandatory.  Fill in other lines if you want that information included in your customized song (applies to Original song selections only; see below)

 

CONTACT INFORMATION

Name:
Address:
Daytime Phone #: 
Evening Phone #: 
Email Address:

 

POEM  INFORMATION
*Person(s) Name In Poem:
Person(s) Nickname:
Person(s) Age:

Person's Sex:

Relationship To You:
*Occasion:
*Birthday Date:
(If occasion is a birthday) 
*Anniversary Date:
(If occasion is an anniversary)
Spouse's Name:
Children's Names:
Grandchildren's
Names:
Other Names and
Relationships:
Pet Names:
Hobbies:
Other Information:

 

PRICING PLANS

We offer two types of customized poems.  "Personalized" poems are less expensive, but only use the information marked with an "*" above.  Original poems are more expensive, but are written originally for each customer and use all or most of the information filled in above.
ITEM ITEM DESCRIPTION COST

PERSONALIZED POEM 
GIFT PACKAGE

Beautifully printed verse sheet without music $ 21.95
ORIGINAL POEM
GIFT PACKAGE		 Beautifully printed verse sheet without music $ 69.95
VERSE SHEET   FREE!!
FRAMED VERSE SHEET Non-matted Framing
Matted Framing		 $ 49.95
$ 64.95
FRAMED VERSE SHEET
WITH PHOTO		 Non-matted Framing
Matted Framing		 $ 59.95
$ 74.95

PRODUCTION PREFERENCES - Please check all that apply

MOOD DESIRED:
STANDARD POEM 
ORIGINAL POEM
FRAMED VERSE SHEET
FRAMED VERSE SHEET
WITH PHOTO

Fifty percent (50%) of the order total is due prior to beginning work on your song, with the remaining balance due at completion.
We will contact you to review the above information prior to beginning the song development process to ensure all information is complete and correct, and to make arrangements for including a photo on the lyrics sheet if desired.
This form can be returned by clicking the "Submit" button below, or by calling in the information at (727) 844-3200 or (908) 419-8155.
Please see our copyright restrictions to understand your rights regarding the use of your customized song.

Thank you for your order.  We will contact you within 2 business days to 
confirm your order.
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Tel.#:

 (727) 844-3200

Email: 

info@keepsakefamilymoments.com


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