Please complete this form to order your stork and make sure you complete the sections noted with an (*)

Preorders: Select "pre order" if gender is unknown, type (unk) in names that are not known at time of order, type Due Date in Date of Birth, (00) in dates and weights.

Click here to skip ahead to the gift certificate section.

Baby Information

Baby #1

Baby #2
(if you need storks for triplets or more, please enter information for the first 2 babies, then return and fill out information for the remaining babies)

Gender*

boy girl pre order

Gender*

boy girl pre order

Baby's First Name*

Baby's First Name *

Baby's Middle Name*

Baby's Middle Name*

Baby's Last Name

Weight
(enter 0 if no oz) *

Lbs Oz.

Weight
(enter 0 if no oz) *

Lbs Oz.

Length (example: "20 3/4 in.") *

Length (example: "20 3/4 in.") *

Date of Birth *

/ / mm/dd/yyyy

Time of Birth (example: 4:20) *

Time of Birth (example: 4:20) *

Mother's First Name *

Father's First Name *

Delivery Information

Requested Delivery Date (mm/dd/yyyy)*
/ /

Delivery Street Address *

Neighborhood Name (enter N/A if none) *

City State Zip*
,

Delivery Receiver Phone Number *

Delivery Receiver Cell Phone Number

Gift Certificate Information

For Name *

From Name *

Delivery Address *
Street
City
State   Zipcode

In the Amount of: $0 $25 $50 $75 $100 *
Other amount (increments of $25 only please):

Optional Brief Message to Receiver:

Payment Information

Rental Time and Price:*
Select One Standard Stork, 1 day - $40 Standard Stork, 7 days - $65 Personalized Stork, 1 day - $50 Personalized Stork, 7 days - $80 Standard Bundle (7 days) - $30 Personalized Bundle - $40
If twins, triplets, or quadruplets, please select one:
none twins triplets quadruplets

Additional Days ($5 each day)? 0 1 2 3 4 5 6 7

Extra Bundle ($15 each)? How many: 0 1 2 3 4 5

I will pay by:* cash check credit card

If this is a gift for some one else, please provide your name (first and last please):

Orderer's Email Address:*

Additional Comments (and special requests):

We will contact you with the final total of your order.