Valentine Order

Singing Valentine Order Form

Questions: "[email protected]" or 856-979-5610

Sender Contact Info

Your Name *

The full name of person ordering the Valentine

Your Email *

Your Phone *

xxx-xxx-xxx

Your Location

City and State

Your Mugshot

You can upload a head shot to be included in the video presentation.

Uploaded files must be less than 2 MB. Allowed file types: gif, jpg, png.

As an alternative way to send us your photos, you can Email to "[email protected]" and attach your pictures. (gif, jpeg, jpg, png)

Recipient Info

Recipient Name *

Recipients Full Name

Recipient Nickname *

Recipients name to be used in Video. (i.e. "Aunt Beth" , "Nanny" , "Cathy" ,etc.)

Recipient Mugshot

You can upload a head shot picture for inclusion in the video.

Files must be less than 2 MB. Allowed file types: gif, jpg, png.

As an alternative way to submit your photos for inclusion in the video, you can Email to "[email protected]" and attach the pictures (gif, jpeg, jpg, png)

Sender greeting *

The inscription on the video card. (To Mary with Love from John), (We love you Aunt Bess) , etc.

Relationship to Sender *

You will have the opportunity to contribute to our fund raising effort immediately after your successful submission.

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Mail: P.O. Box 417, Moorestown, NJ 08057