I am sorry, but I cannot make you a Card out of that information. Please Fill out the Form completely or at least give some kind of acknowledgement as to which Template you want.
Making T-Cards is my buisness and I'm always happy to do it, but I cannot do it if people keep just posting Random Information. That's the reason we have Forms. I really hate being strict and coming off mean, so please, to any frequest T-Card Requesters... If the Owner of the Shop provides a Form, please fill it out completely. They're there for a reason.