Insult Request Form

Once your personalized message is recorded it will be emailed to The Jerk of your choice and to yourself. We'll record and send your message as soon as possible. The time it takes just depends on the amount of requests we receive.

Your email address will not be shared with The Jerk or anyone else but we need it to send you a copy of the insult message.

	Your Name On Message	The Jerk's Name
	Your Email Address	The Jerk's Email Address
Tell us what makes Your Jerk a Jerk! By submitting, you agree to have an insult sent to The Jerk you named and a copy sent to yourself. You also agree that any insult created by request is the sole property of www.makehimpay.net and may be used in other projects on and off our site. I accept: