| Personalized by Design (800) 945-5522 |
Birth Announcement
Candy Bar ORDER FORM |
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| DURING
THE SUMMER MONTHS PLEASE INFORM IF WE SHOULD PACK WITH A COOLER YES[ ] No [ ] (Please check one) |
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| Unmelted chocolate not guaranteed unless shipped in cooler to warm
climates with no more than 1-4 day transit time. |
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| BABY INFORMATION |
BOY
[
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GIRL [
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MULTIPLES [ ] (Use separate form for each
baby) |
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| Baby's Name: |
FIRST |
MIDDLE |
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LAST |
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| Date of Birth: |
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Time: |
______:______ [ ] a.m.
[ ] p.m. |
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| Weight: |
______lbs. ______oz. |
Length: |
______inches |
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| Birthplace: |
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| Mfd. by (Parents): |
______________________
and ______________________
_________________________ |
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MOTHER
FATHER
LAST (Optional) |
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(Note Brother
or Sister next to Unisex names:
i.e.: Jordan, Jamie etc.) |
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| Baby's Hometown: |
CITY
STATE ZIP |
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| Mother's Maiden Name: |
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| Quantity:__________ |
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DESIGN:__________ |
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Graphic
Choice:__________ (NB1&3 Only) |
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| With Chocolate [ ] Wrappers only [ ] [ ] (Hershey Bars Add 20 cents) |
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(Bear will be used if not
indicated) |
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| Transit time depends on time and day of
receipt of order. Shipping Charges are based on Quantity and Zone. |
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| Ship
Via Ground (3-7 day) [
] Second Day (3-4 day) [ ] Express
(1-3 day) [ ] |
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| Transit time based on
your zone location from New Jersey . |
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| Is this a gift? Yes [ ] No [
] GIFT WRAP [ ] (includes small enclosure card) $6.00
LARGE GIFT CARD [ ] $2.25 |
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| Note
for Enclosure card/Gift Card:
____________________________________________________________ |
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| Payment: |
We accept: VISA, MASTER CARD, DISCOVER, CHECK CARDS, AMEX |
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| Card Number:
|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Exp. Date: ___/___ |
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| Name as it appears on
card:____________________________________________ |
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Card Holder Phone: |
( ) - |
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| Authorized Signature: |
X___________________________________________ |
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| **IMPORTANT: Please provide Credit Card billing address in BILL TO: if different than Ship To:** |
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| Bill
To: |
NAME |
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Ship To: |
NAME |
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ADDRESS APT# |
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ADDRESS APT# |
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CITY/STATE/ZIP |
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CITY/STATE/ZIP |
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| Checks and Money Orders also gladly
accepted. Allow 2 weeks clear time for checks |
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| Please call for
shipping price if paying via Money order or Check |
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| Mail completed form
to: |
Personalized by Design |
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1141 Greenwood Lake Turnpike |
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Ringwood, New Jersey 07456 |
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Click to return to
www.Personalizedbydesign.com |
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