Claudia Baudo - Custom Baby Gifts, Baby Plates, Dinnerware, Housewares, Ceramics and Pottery

Footprints CUSTOM Birth RECORD Plate
Designed by Claudia Baudo

Please complete the following FIVE SECTIONS of information so that we may begin your order.
Please DOUBLE CHECK that all information is spelled correctly before submitting order! Thank you.

SECTION 1
BABY'S INFORMATION

SEX OF BABY:
BABY'S FIRST NAME:		BABY'S MIDDLE NAME:
BABY'S BIRTH WEIGHT:	LBS. OZ.	BABY'S BIRTH DATE:	MO. DAY YEAR
BABY'S BIRTH TIME:
SECTION 2 YOUR INFORMATION
YOUR FULL NAME:
ADDRESS:
CITY, STATE, ZIP:
TEL:
EMAIL:
SECTION 3 SHIP TO INFORMATION
FULL NAME:
ADDRESS:
CITY, STATE, ZIP
TEL:
SECTION 4 HOW DID YOU LEARN ABOUT US?
If you chose 'Other', please briefly explain in this space:
SECTION 5 PAYMENT INFORMATION (VISA, MC, AMEX ONLY!)
CREDIT CARD TYPE:
CARD #:
EXPIRATION DATE:	MO. YEAR:
NAME ON CARD:
	After clicking SUBMIT you will be redirected to our HOME page. THANK YOU FOR YOUR ORDER.� If you are NOT redirected to our homepage, your form did NOT go through. Please try again or contact me directly at 201.245.5176 or email at inquiry@paintedseed.com