Wedding 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 Wedding, Anniversary or Special Occasion. Make sure to use upper and lower case letters while completing this form. (example: Jane Smith, not JANE smith)

First Names to Appear at the Top of the Keepsake

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First Person's Full Name Second Person's Full Name First Name (required) Middle Name (optional) Last Name (Maiden) (optional)

Choose One:	On Our Wedding Day In Honor of Our ___ Anniversary On Our Special Day
Choose One:	11x14 Keepsake     8x10 Keepsake 8x10 Poem: Marriage Anniversary
Wedding Date *	(required)
(Now available for wedding dates from January 1, 1950 thru today.)
Anniversary Years
Enter the Number of Years and st, nd, rd, th to make 2nd, 10th, etc.

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Design Choices
Border Design	Hearts & Doves    Meadow
Frame	11x14 Blue    11x14 Oak    11x14 Pink    11x14 White    8X10 Blue    8x10 Oak    8x10 Pink    8x10 White

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Time of Wedding	: AM    PM
Facility Name
City State or Country
Officiated By Title Name

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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

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Order Details Item Qty Price Total Framed Wedding Keepsake(11x14) X $32.99 $_________ Framed Wedding Keepsake(8x10) X $27.99 $_________ UnFramed Wedding Keepsake(11x14) X $12.99 $_________ UnFramed Wedding Keepsake(8x10) X $9.99 $_________ Gift Wrap X $4.95 $_________ Additional Shipping for each Framed Keepsake/Poem 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 ____________________