Online Order Form

Newborn Information
Number of Boys:	Number of Girls:
First Baby's Full Name
Second Baby's Full Name
First Baby's Weight	Pounds Ounces
Second Baby's Weight	Pounds Ounces
Date of Birth
Parents' Information
Mother's Name:
Father's Name:
Delivery Information (Delivery fee may apply)
Deliver to (recipient name):
Address:
City:
State:
Zip Code:
Recipient Phone:
Requested Delivery Date for Stork:
Acceptable Dates of Delivery:
Package:	Single Stork:
Rental Period:
Birth Announcement Candies
N/A
Your Address Information
Check Here if same as recipient:
Your Name:
Address:
City:
State:
Zip Code:
Your Phone:
Your Email:
Your cell/pager number:
Payment Information
Credit Card Type:
Card Number:
Card Expiration Date:
Card Holder's Name:
SNLI Account:
Personalized Note to be written on Gift Card


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