Growth Chart 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)
Name to Appear at the Top of the Chart	(optional)
	11 characters max, A~Z, hypens and spaces only
Child's Full Name to Appear Under the Poem	(optional)
Child's Birth Date	(optional)
Birth Weight	Pounds, Ounces OR Grams (optional)
Birth Length	Inches    Centimeters (Ex: 20-1/2 inches or 51.9 centimeters)

Special Instructions

Gift Information

If this Growth Chart 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 Personalized Growth Chart X $16.99 $_________ Shipping   $_____2.99 Subtotal   $_________ 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 _________________________