Your Polachecks Moment

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Fill out this form
Your Name * Partner's name*
Address

Street Address Line 2

CityState

Zip Code
What type of story do you have to share?

Email Address*
example@example.com
Tell us how you met*
Tell us your proposal or wedding story
Describe your ring or special gift*
Share photos of your special occasion*

Cancelof
Your Instagram Username

Partner's Instagram Username
Sales Associate

Were the photos submitted taken by a professional photographer?
Photographer Facebook Username

Photographer Instagram Username
Should be Empty: