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Make check or money order payable to:
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My
Birthday Wish - Your child learns the value of
self respect
Child's Birthdate: ___________________________________
Age__________ Boy________Girl__________
Gift date to be printed in book: _________________________________
First Name______________________
Last Name__________________________________Nickname___________________
Hometown________________________________________State__________________
List three friends or relatives:
1_____________________________________2____________________________________
3_____________________________________
Dedication: (With Love From, Kisses From, etc.)_____________________________________________________
This book is from: (Mommy & Daddy, Nana Ruell, Auntie Lisa, etc.)_____________________________________
Customer Information: Name_______________________________ |
Shipping Information - If Different Name_______________________________ |
If we have a question: E-mail or
Telephone: ___________________________
We will not call unless we have a question on your
order...we will not sell your address.
$14.00 Per Book |
$3.00 Shipping First Book |
Number of books_______________ |
