Birth Order Form

Fill Out form On Line to Order or Print to Your Printer to Phone or Fax in Later.

HERESHEIS wrappers HEREHEIS wrappers
Please enter quantity you are ordering (50 minimum)
Add a Full Color or B&W Picture
Prices

Ms.Goodgirl wrappers Mr.Goodboy wrappers Lil'Honey wrappers Sweetheart wrappers
Please enter quantity you are ordering (25 minimum)
Add a Full Color or B&W Picture
Prices
Please send wrapped candy bars. I understand there is an additional charge.

Baby's Name (as you want it to appear on front)
Weight Lb.Oz. Length
Day and Date of Birth
Time of Birth AM PM(Please choose one)
Horoscope "Born under the stars of" (optional, no charge) Click on it!

City and State Where Born
Delivering Doctor, Midwife, CNM, etc. (Please specify)

Hospital, Med. Center, etc. (as you want it to appear)
Parents' Names
Siblings - please specify brother(s) and/or sister(s)
Grandparents
Other info

Regular size WRAPPERS
HERESHEIS ............... fits 1.55 oz. HERSHEY® Milk Chocolate candy bar
HEREHEIS ............... fits 1.45 oz. HERSHEY® with Almonds candy bar
Check this box if you want your HEREHEIS wrappers to fit the Milk Choc. bar
Ms.Goodgirl and Mr.Goodboy wrappers are designed to fit 1.75 oz. Mr.Goodbar® candy bars.
Lil'Honey wrappers fit 1.7 oz. Bit-O-Honey® candy bar

MINIATURE WRAPPERS ALSO AVAILABLE to fit Hershey® assorted miniatures
Please enter quantity you are ordering

Yellow Highlight area is for Credit Card Billing Info:
Please be complete and accurate on all sections of the form.
Thank You!

Master Card Visa Discover Amex Number--- Expires
Name as it appears on card and approval to charge card for this order
V-Code (click here to find it)
Credit Card Billing Address
No. & Street
City, State Zip
Phone in Card number if you prefer Toll Free (877) 685-6397

Ship Wrappers To:

Orders are printed EVERY DAY! Mon. thru Fri.
*guaranteed next day with FedEx
*Orders received by 12 noon PST ship the same day. (FedX guarantee guidelines apply)

Or use Priority Mail by the US Postal Service, usually 2 to 4 days for delivery. (not guaranteed)

CHOOSE ONE Priority Mail FED X
Choose this box for FedEx to leave without signature
Choose this box for Saturday Delivery
Prices
Orders placed on Friday by noon can be delivered Saturday with FedEx
Your order will arrive Monday if Saturday delivery is not checked.

*Phone Number (Best to contact you) required
Phone Number (secondary)
E Mail address

Is this a gift?
Give us your mailing address to send the receipt and sample to.
(if different than “Ship To”)

Additional comments:

Where did you hear about us? or How did you find us?

THANK YOU FOR YOUR ORDER!
You will see a confirmation page when you “Submit Order”
If you need to make revisions, come back to this form then submit again.
We will use the last form you submit.