Birthday Keepsakes Order Form
Please complete this form and then fax or mail it to us.
FAX (970) 669-5052 (credit card orders only) Please allow 2 - 3 weeks for delivery.		Birthday Keepsakes LLC P.O. Box 7679 Loveland, CO 80537-0679 Please allow 4 - 5 weeks for delivery. Please include check, money order or credit card information with order form.

Please tell us about your child. Make sure to use upper and lower case letters while completing this form. (example: Jane Smith, not JANE smith)
Child's First Name	(required)
Child's Middle Name	(optional)
Child's Last Name	(optional)
Child's Gender	Girl    Boy
Child's Birth Date	(required)
(Now available for birth dates from January 1, 1950 thru today.)

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Design Choices
Size	11x14    8x10
Border Design	Bears    Boys    Dolls    Fish    Girls    Meadow    Noah    Party    Sports    Toys
Frame	11x14 Blue    11x14 Oak    11x14 Pink    11x14 White    8X10 Blue    8x10 Oak    8x10 Pink    8x10 White

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Please provide the following information, if available.
Time of Birth	: AM    PM
Birth Weight	Pounds, Ounces OR Grams
Birth Length	Inches    Centimeters (Ex: 20-1/2 inches or 51.9 centimeters)
Hospital Name	(Up to 35 characters)
City
State or Country

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Special Requests

If you would like to make a special request, please enter it here.

Gift Information

If this Keepsake is a gift, please tell us what you would like to say on the gift note. You have up to 3 lines and 30 characters per line.

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Ship To			Bill To
Name			Name
Address			Address
City			City
State			State
Zip			Zip
Country			Country
Email			Phone
			(in case we have questions about your order)
Would you like to receive informative Birthday Keepsakes mailings in the future? Yes No

Order Details Item Qty Price Total Framed Birthday Keepsake(11x14) X $32.99 $_________ Framed Birthday Keepsake(8x10) X $27.99 $_________ UnFramed Birthday Keepsake(11x14) X $12.99 $_________ UnFramed Birthday Keepsake(8x10) X $9.99 $_________ Gift Wrap X $4.95 $_________ Additional Shipping for each Framed Keepsake X $4.00 $_________ Subtotal   $_________ Shipping   $_____2.99 Sales Tax   CO residents add 3.7% sales tax   (0.037 x Subtotal)   $_________ Total   $_________

Payment Information I am paying by    Visa        MasterCard    American Express           Check        Money Order Credit Card Number Name on Card Expiration Date / Signature _________________________