Order Birthdate History

[ Back to Gift Gallery ]

This form will allow you to design and order your Birthdate History.  Please complete the following information.

If you prefer ordering by telephone, fax or mail, see instructions at 4 Ways To Order.

1)  Buyer Information~

Buyers Name  
Street Address  
Address (cont.)
City  
State/Province  
Zip/Postal code  
E-Mail Address
Telephone  
How did you learn about Gifts of History?
If you are ordering from mailing piece you received please put code or tracking number here:
 

2)  Ship To Information~

If shipping information is the same as buyer information, check this box and proceed to section 3.

NOTE:   If shipping information is different than buyer information, the mailing label will state "This is a gift from Buyer".

ShipTo Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal code
Telephone


Do you want a gift message? If so type here:


3)  Personalization Information~

The following is required information for personalizing your certificate:

First Name
Middle Name
Last Name
City Of Birth
State Of Birth
Date Of Birth Month   Day   Year

4)  Optional Personalization Information~

Time Of Birth
lbs ounces inches
Name Of Hospital
Name Of Doctor

5)  Design Options~

Choose Framed or Unframed | And Also Choose Your Border

Framed     Unframed | Border A   Border B

NOTE:  If you choose Framed, please select a FRAME COLOR below,
otherwise skip to next section.

Choose A Frame Color

Dusty Rose   Shadow Blue   Golden Oak
Pearl White    Mahogany

6)  Your Order and Cost~ (Select One)

Item Cost Plus Shipping
and Handling 		Price Qty Total
(Price X Qty)
Birthdate History Framed 34.95 7.95 $42.90
Birthdate History Unframed 12.95 3.95 $16.90
Are You a Florida Resident? If So Please Select "YES" :  
Florida residents are required by law to pay 7% sales tax on Internet Orders  

FINAL TOTAL (Amount to charge credit card):

A separate order form must be completed for each Gift Of History.

Unframed Birthdate Histories are shipped flat via First Class mail.

Framed Birthdate Histories are shipped via UPS.

7)  Payment

Credit Card Type:

Name On Credit Card:

Credit Card Number:

Expiration Date:

mm/dd/yyyy

8)  Enter any additional comments or questions below~

Please contact me as soon as possible regarding this matter.

9)  Place Your Order!

If ordering online, simply click SUBMIT ORDER ONLINE below and your order will process immediately.

For telephone, fax or mail orders, complete and PRINT this form for your records and see 4 Ways To Order for further instructions.   Thank you!

Gifts of History
P.O. Box 128
Green Cove Springs, FL 32043
Phone 1-800-494-1200
Fax 904-284-4186

 

PLEASE CLICK SUBMIT ONLY ONCE OR YOU WILL RECEIVE MULTIPLE ORDERS
DUE TO FORM VALIDATION, THANK YOU.

 

[ Back ]