Aww, cute example! :)
My form!:
Name; JeSsiCaTmEoWw (No, don't put it in the picture :]! Feel free to sign it, though!)
Example of what you want drawn; Umm, this:
Any certain pose?; Whatever you want!
Bust, Headshot or Fullbody?; Fullbody, please! :)
Thank you so much! :D