Wild at Heart Order Form

Surprise your Valentine with a special Wild at Heart Package!

Choose from two great packages for your Valentine(s)!

Deadline for in-town delivery is February 10th.

Wild At Heart Adoption Package
$35
- Stuffed Plush of Adopted Animal
- Valentine Chocolate
- Certificate of Adoption
- Animal Photo
- Animal Fact Sheet
"This Poo Made Me Think of You" Package
$15
- PooPooPaper(tm) 4" x 4" notepad, made of recycled and odorless paper products and animal poo.
  (Note: designs will vary between orders)
- Valentine Chocolate
YOUR (SENDER) INFORMATION:
Full Name*

First NameLast Name
Daytime Phone Number*
E-mail*
example@example.com
RECIPIENT(S) INFORMATION:

You may order UP TO 3 Wild at Heart Packages on this form. If you wish to purchase more than 3, please submit another online order form or call our gift shop at 785-827-9488.
RECIPIENT #1:
Recipient #1 Name*

First NameLast Name
Select Your WAH Package for Recipient #1

Adoption Package - Rhino $35Adoption Package - Flamingo $35Adoption Package Snow Leopard $35Adoption Package - Lemur $35PooPoo Notepad Package $15
Delivery, Pick-Up or Shipping for Recipient #1

Delivery In-Town Salina (Free)No Delivery. I will pick up at the Zoo. (Free)
PACKAGE DELIVERY - In-town delivery address / Out-of-town mailing address

Street Address

Name of Business if applicable

CityState

Zip Code
Gift Card To:*
Name of recipient as you'd like it to read on gift tag
Gift Card From:*
Your Name as it will read on gift tag
RECIPIENT #2:
Recipient #2 Name

First NameLast Name
Select Your WAH Package for Recipient #2

Adoption Package - Rhino $35Adoption Package - Flamingo $35Adoption Package - Snow Leopard $35Adoption Package - Lemur $35PooPooPaper Notepad Package $15
Delivery, Pick-Up or Shipping for Recipient #2

Delivery In-Town Salina (Free)No Delivery. I will pick up at the Zoo. (Free)
PACKAGE DELIVERY - In-town delivery address / Out-of-town mailing address

Street Address

Name of Business if applicable

CityState

Zip Code
Gift Card To:
Name of recipient as you'd like it to read on gift tag
Gift Card From:
Your name as it will read on gift tag
RECIPIENT #3:
Recipient #3 Name

First NameLast Name
Select Your WAH Package for Recipient #3

Adoption Package - Rhino $35Adoption Package - Flamingo $35Adoption Package - Snow Leopard $35Adoption Package - Lemur $35PooPooPaper Notepad Package $15
Delivery, Pick-Up or Shipping for Recipient #3

Delivery In-Town Salina (Free)No Delivery. I will pick up at the Zoo. (Free)
PACKAGE DELIVERY - In-town delivery address / Out-of-town mailing address

Street Address

Name of Business if applicable

CityState

Zip Code
Gift Card To:
Name of recipient as you'd like it to read on gift tag
Gift Card From:
Your name as it will read on gift tag
Please verify that you are human*

Select Your Package(s) and any Applicable Shipping:*

Wild at Heart Adoption PackagePlush, photo, certificate, chocolate

$35.00 Quantity

"This Poo Made Me Think Of You" Package4" x 4" PooPooPaper Notepad, chocolate

$15.00 Quantity

Total

$0.00

Payment Method

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: