CUSTOM  MEMORIES

    Please fill in the following form and press submit:

First Name:   Last Name:

Street Address:

City:   State:   Zip:

E-mail: 

Phone:

Please select CD or Cassette:  Shipping/handling $4.99

Select Method of payment: 

credit card number: expiration:

You can call in your credit card number if you would like:  866-788-9552 or Fax 801-459-3337

If Paying by check or Money order please mail to: Power Alley  1935 State Route 12    Binghamton, NY 13901

How did you find out about Custom Memories?  Where you referred by someone?

Please answer the following questions.  Please include as much information as possible.  This will allow for the best results.  If you need more space please fill in the extra information box. 

 

First name of the person this is for: 

Please select the style of music she/he likes: 

Where did you first meet? 

How did you first meet?

What is your fondest memory together?

What nicknames do you call each other?

What are some cute habits that he/she have?

What are your favorite things that you do together?

What are some of the favorite places you like to go together?

Have you ever bought her(him) something she(he) thought was special?

What are some things things you like about her(him)

Describe her(him):   Hair

Eyes

Face

Smile

Misc. 

Where are you from?

Where is she(he) from?

What do you want the theme to be? 

EXTRA INFORMATION:  (anything extra you can tell us to make it more personalized)

 

Please allow 30 business days for delivery. 

Would you like rush delivery(10 business days) for an extra $29?