order form for feedback (PDF)

Want a custom song?
For a base price of only

$20, we will create for a 2-3 minute piano song with chords based off of one

provided source of inspiration from your life, an event, a person, or a memory.
source of inspiration with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
example my child's laughter___________________________________________
1. bubbly__________________
2. unpredictable_____________
3. upbeat__________________

What type of sound would you like? (check one)
__ lighter/brighter
__ darker/heavier
if you have a specific key you would like, please list it here ____________

Would you like to name it?
_______________________________________

Optional choice of (circle one)
3:4 time (triplet feel)
4:4 time (duplet feel)

The piece comes as an MP3 file, with permission to put it on as many devices as you wish.

Customer Information
Name: _____________________________________________________________________________
Phone Number: ______________________________________________________________________
Email/text/fb profile/written communication preference ________________________________________

*insert waiver and signature here*

Additional Customization Options
$3- per additional inspiration (see back of page)
_____(how many?)
$5- per additional 8ms melody
_____(how many?)
$5- per additional instrument (check which ones)
_____voice
_____flute
_____clarinet
_____tenor saxophone
_____cello
_____drumset
$2- choose your own form (must conform to the # of purchased melodies) (A, AB, ABA etc)
_____
$1- choose your own time signature
_____
$2- per additional key (do you want it to change from lighter/brighter to darker/heavier or vice versa?)
if you have a specific key you would like, please list it here
____________
$2- per additional time signature
_____
$5- to add lyrics that you provide (if purchasing vocals with words)
_____
$15- for me to create lyrics (if purchasing vocals with words)
_____
$5- youtube video with customer provided photos/video as the background
_____
$3- to include a 12 second ringtone version
_____
$5- to also receive a PDF copy of the music
_____

Additional sources of inspiration
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________
source of inspiration ___________________________________________ with up to 3 descriptive words
1. __________________
2. __________________
3. __________________