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Baby Diapers Delivery Order Form

 

Order Information (2 of 4)

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

(Please check one)

I would like to order:

Diapers size:

Send delivery date:

Cases for delivery:

Unit Cost:

$43.95

Shipping and handling:

$8.95 waived for the 1st order  Shipping details

 

 

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

Shipping information * (3 of 4)

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 (4 of 4)

 

 

 

  Accepted via PayPal (Easy and secure!)

 

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