Please fill out the following form and press the SEND button. Care is taken that each Wallajumper poem is written to a high standard, but it is only as accurate as the information you provide. Please take your time filling out this form, including details, details, and details. Personal stuff too! I may not use everything, but I will get a good feel for how the poem should be written for you. Let's get started, below!

Where do you live? Country Province/State

Using poem for what occasion or purpose?

Who is it for?

Who is it from?

Relationship of who it's for to who it's from.

How will the poem be presented?


Tell me about who it's for.

Name Age


What does that person do?

Do you have a story, or several, to tell?

Any Memorable moments?

Any Funny characteristics about this person?

Any embarrassing moments that you'd like to share?

Any other interesting tidbits about who it's for ?

Any special message that needs to be conveyed?

Any other details that the above questions do not address?

Is there anything from the above details that you've provded that is for information only and is NOT to be used in the poem?

Please select size of poem :

Note: for more than 5 pages, click on SEND at the end of the form to send your completed form to me directly, but don't complete the purchase yet. I'll send you a quote to your email address, and then you can click on the BUY NOW button to complete your purchase through Paypal.