In need of some advice!

[roannachan.livejournal.com]

 I looked back for advice about this but I may not have looked back far enough and I'm running out of time a bit. 

I'm getting ready for Anime:USA and will be selling things in Artist's Alley. One of the items I'm offering is Scrabble tiles turned in to either pendants or rings. I have pre-made designs, but I also did a few tests to see if I could do original art that small, and I can! I'd like to offer original art commissions for the pendants, but I'd like to have some sort of form for people to fill out with info on what they want drawn, description of the character, that sort of thing. Does anyone have a sheet like this that I could see? I'm so brain-fried that I can't even think of what I should put on this thing. I'd have to mail the rings or pendants out to people after the convention because of how long it takes for the glaze to dry, so it definitely needs to have a space for a mailing address.

Anyone help me out? Thanks!