Singing Valentines Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Order a singing valentine for someone you love! These live performances or personalized digital messages will be delivered to your special someone the week of Valentine's Day!

Use this form to request your singing valentine. Please note, since there is an option of a live performance, we may have to contact you to make this experience as safe and sincere as possible!

Digital Valentines are $5 and In-Person Valentines are $15

Purchaser's First Name *

Purchaser's Last Name *

Purchaser E-mail Address *

Purchaser Phone Number *

Recipient First Name *

Recipient Last Name *

Recipient Pronouns *

She/Her

He/Him

They/Them

Other:

Required

I am ordering. *

An IN PERSON singing valentine to be delivered the week of Valentine's Day ($15)

A DIGITAL singing valentine to be e-mailed on Valentine's Day ($5)

Recipient E-mail

If you chose IN PERSON: What is your prefered day to have the valentine delivered?

Thursday, February 10th

Friday, February 11th

Monday, February 14th

If you chose IN PERSON: When and where should we deliver this valentine? Include times, locations, and any other relevant details.

Select a song: *

Serenade to a Girl/Boy

For the Longest Time (Billy Joel)

Brown Eyes

Payment

Within 24 hours of submitting this form, you order will be processed by a brother of the Alpha Xi Chapter and you will receive a PayPal Invoice which allows you to make a secure digital payment. This must be paid before your order can be completed and your valentine delivered. You may always contact us at alphaxiexec@gmail.com regarding your order.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms