Stork News of Fayetteville
WORK RECORD
ORDER DETAILS
*
Boy
Girl
3-5 Day Rental
7 Day Rental
Pre-Order
Other
NEWBORN INFORMATION
NAME
First
Middle
Last
Suffix
WEIGHT
DOB
-
Month
-
Day
Year
PARENT INFORMATION
NAME(S)
Mother's First Name
Father's First Name
COMMENTS
DELIVERY INFORMATION
MAILING ADDRESS
*
Street 1
Street 2
City
State
ZIP
SUBDIVISION NAME
IS THIS A GATED AREA?
Yes
No
GATE CODE
PHONE NUMBER
-
Area Code
7-Digit Number
PHONE TYPE
Cell
Home
Work
EMAIL ADDRESS
ORDERING INFORMATION
NAME OF PERSON ORDERING
*
First
Last
MAILING ADDRESS
Street 1
Street 2
City
State
ZIP
PHONE NUMBER
*
-
Area Code
7-Digit Number
PHONE TYPE
Cell
Home
Work
EMAIL ADDRESS
GIFT CARD MESSAGE
PAYMENT DETAILS
Please call us at (910) 461-5389 to submit payment details and finalize your order and requested items.
SPECIAL INSTRUCTIONS
Please call us at (910) 461-5389 to submit payment details and finalize your order and requested items. Do not enter payment information in this form.
ADDITIONAL INFORMATION
WOULD YOU LIKE TO ADD A SIBLING OR DOG SIGN TO YOUR ORDER?
Yes
No
SIBLING'S NAME & GENDER #1
SIBLING'S NAME & GENDER #2
DOG'S NAME & GENDER #1
DOG'S NAME & GENDER #2
SUBMIT
Should be Empty: