UR Baby Diapers Delivery E-Store - Discount Baby Diapers Delivery Service -

Baby Diapers Delivery Order Form

(Do not use this order form if you are ordering a single case of diapers. Thank you)

Order Information (1 of 3)

This order is: For me For a family member A gift A donation

(Please check one)

I would like to order:
Diapers size: (For multiple selections hold down Ctrl button on the keyboard then click) (Use the comment text area bellow to send us any additional order details)
Send delivery date:
Cases for delivery:
Unit Cost:	$43.95
Shipping and handling:	$8.95 Shipping details
Subtotal:
Discount and savings:

Please note: We do not ship to P.O. Box addresses

Shipping information * (2 of 3)

Please fill in all * required fields.

First Name:

Last Name:

E-mail:

Address:

Apt/Suite#

City:

State/Region:

Zip Code/Postal Code:

Phone:
()

How Did you hear about us:

Comments or questions

Submit information

Before you click the submit button

Please review your information, and make sure that

All necessary information has been filled out.
All information is error-free.

All information is correct and fraud-free.

For Fraud Prevention purposes, we have:

Recorded your IP Address
The time of your order submission

After you submit your order.

Please come back to this page and finish the payment information section.

THANK YOU.

Payment information (3 of 3)

Accepted via PayPal (Easy and secure!)

Click the appropriate button according to the number of cases ordered.

2 cases	3 cases	4 cases	5 cases	6 cases

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