| YOUR FIRST NAME: | |
| YOUR LAST NAME: | |
| YOUR EMAIL ADDRESS: | |
| YOUR DAYTIME PHONE NUMBER (please include dashes): | () - |
| YOUR EVENING PHONE NUMBER (please include dashes): | |
| YOUR MOBILE PHONE NUMBER (please include dashes) | |
| COMPANY NAME (where applicable): | |
| IF REQUESTED, YOUR FAX NUMBER: | |
| FIRST NAME OF RECIPIENT: | |
| LAST NAME OF RECIPIENT: | |
| OCCASION: | |
| DELIVERY DATE: | |
| TIME WINDOW FOR DELIVERY (must be a minimum of 30 minutes): | |
| CAN YOU PROVIDE A CONTACT PERSON FOR THIS DELIVERY? (TYPE NAME HERE): | |
| CONTACT PERSON'S PHONE NUMBER: | () - |
| ADDRESS FOR DELIVERY: | |
| PLEASE PROVIDE DRIVING DIRECTIONS FROM RDU (NO MAPQUEST, BUT IN YOUR OWN WORDS...MAKE SURE TO INCLUDE DISTANCE BETWEEN EVERY TURN!): | |
| HUMOROUS, ROMANTIC, OTHER (please define): | |
| DISPOSABLE CAMERA FOR "CAPTURING" THE MOMENT? (to be either left with recipient, or mailed to you afterwards): | |
| DO YOU WISH TO ADD ROSES? | |
| PAPER-WRAPPED, OR IN A VASE? | |
| SPECIFY HOW MANY, AND 1st/2nd COLOR CHOICE: | |
| SONG CHOICE: | |
| ARTIST (WHERE APPLICABLE): | |
| RECIPIENT'S FAVORITE MUSIC GENRE: | |
| PERSONALIZED SONG INFO (PLEASE PROVIDE AT LEAST SIX DETAILS. You are not limited to the suggestions below, so feel free to add your own): | |
| NICKNAMES: | |
| FAVORITES (junk foods/drinks, schools, sports, hobbies, people, politics, places... | |
| DISLIKES AND IRRITANTS: | |
| LOVE INTEREST: | |
| MEMORABLE MOMENTS (FUNNY OR EMBARRASING): | |
| ADDITIONAL COMMENTS (please make sure you have included your email address in the field above): | |
| PLEASE ENTER FEE QUOTE YOU RECEIVED FROM OUR OFFICE FOR THIS DELIVERY | |
| PAYMENT METHOD (CASH, CHECK, MASTERCARD OR VISA): | |
| CREDIT CARD NUMBER (A $5.00 FEE IS ADDED TO ALL CREDIT CARD SALES): | |
| EXPIRATION DATE: | |
| NAME AS IT APPEARS ON CREDIT CARD: | |
| Your charged total will appear on your statement as from LIFE OF THE PARTY, thanks! | |
| WHAT SENTIMENT WOULD YOU LIKE TO BE PRINTED ON THE ACCOMPANYING TELEGRAM? (Like a greeting card that recipient keeps): | |
|
Our office will confirm receipt of your form as soon as we receive it. 