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ONLINE RESERVATION FORM

YOUR RESERVATION WILL NOT BE AUTOMATICALLY CONFIRMED!

WE WILL CALL YOU BACK TO CONFIRM YOUR ORDER

NAME:

HOME ADDRESS:

CITY:

STATE:

ZIP:

HOME PHONE: CELL:

DELIVERY ADDRESS:

IF DIFFERENT - DON'T FORGET UNIT #

CITY:

DELIVERY DATES: FROM

IS THIS A RENTAL PROPERTY?

RENTAL AGENT OR KEY- HOLDER

AGENT OR KEY-HOLDER PHONE NO.:

ITEMS TO BE ORDERED:

QUANITY

FULL CRIB

* YOU ARE REQUIRED TO USE A

PORTA-CRIB

WATERPROOF MATTRESS PAD

PACK & PLAY

BASSINET

TODDLER BED

BEACH CABANA

BED RAIL (1)

EXERSAUCER

HIGH CHAIR

WALKER

BOOSTER SEAT - NO TRAY

BOUNCY SEAT

BOOSTER SEAT W/ TRAY

SWING

CAR SEAT - INFANT

GATE 28" - 42"

CAR SEAT - TODDLER

GATE 29.5" - 50"

CAR SEAT - HIGHBACK BOOSTER

GATE 38" - 60"

CAR SEAT - BOOSTER BASE ONLY

SUPER YARD

JOG STROLLER SINGLE

RAIL NET

JOG STROLLER DOUBLE

POTTY CHAIR

STANDARD STROLLER

POTTY SEAT

DOUBLE S/S STROLLER

INFANT BATHTUB

DOUBLE TANDEM STROLLER

MONITOR

TRAVEL SYSTEM

TRICYCLE W/HELMET

(INFANT CAR & SNAP-N-GO)

PUSH TRICYCLE

WAGON (FOR 2)

DELIVERY REQUESTED:

PICK UP:

COMMENTS:

BILLING INFO: *WE REQUIRE A 50% (REFUNDABLE) DEPOSIT TO CONFIRM YOUR ORDER

CARD NUMBER:

EXPIRATION DATE:

NAME ON CARD (IF DIFFERENT)

BILLING ADDRESS:

CITY: STATE: ZIP:

YOUR E-MAIL:

*WE WILL BE CONTACTING YOU SOON TO GIVE YOU YOUR FINAL

PRICE AND TO CONFIRM YOUR RESERVATION.