My Baby Book Order Form

My Story Books P.O. Box 9585 Colorado Springs, CO 80932

Baby Book(both parents)___Single Mother Version___Single Father Version___

First Name ______________________________(Baby's)

Nickname (optional) _______________________

Middle Name (optional _____________________

Last Name ______________________________ Boy ____ Girl ____

Hometown ______________________________

State/Province ___________________________

Three 1. ____________________________

Friends 2. ____________________________

Or 3. ____________________________

Relatives

Additional Information for My Baby Book

Date of Birth __________ __________ __________

Month Day Year

Time Of Birth ___________________________A.M. or P.M.

Baby's Weight __________ _____________

Pounds Ounces

Baby's Length _________________________________

Delivered By _________________________________

Hospital _________________________________

Mom's First Name ______________________________

Dad's First Name ______________________________

Mail Book To Name ____________________________

Street ____________________________

City _____________________________

State _________________Zip_________

Each Book ................................................................... $15.95 _______

S & H 3.95 _______

If in Colorado Springs please contact for pick up

or delivery information (719)667-0822

In Colorado Springs please add 6.4% tax Tax _______

Total = _______

A special message from the giver of the book can be placed on the front page

of the book. Just above and just below who the books is from. Example below.

Welcome To Our Family _________________________________

Love, Mommy & Daddy

August 20, 2002 _________________________________

Please keep it brief and make sure all spelling is correct as books are printed

exactly as information is provided. Thank you.

VISA # _____-_____-_____-_____ Expiration Date________

MC# _____-______-_____-______Expiration Date ________

Discover#____________________Expiration Date ________

Name as it appears on card __________________________

Signature if mailing or faxing__________________________

Total # of books ordered _______ Total $_______

S&H=$3.95 1st book $1.50 each additional $________

Please add 6.4% if in Colorado Springs $________

TOTAL$________