Memory Bears and More, Inc.

Memory Bears and More, Inc.
3129 State Road
Ashtabula, OH  44004
Phone: 440-998-7178      Email:



Please print and complete one order form for each bear ordering (unless all to be made exactly the same). Mail to the address above along with clothing, etc.


Mailing address:_______________________________________________________________________


Phone:___________________________               Email:________________________________________

Preferred method of contact if we have questions regarding your order:__________________________



____ Memory Bear – Our original Memory Bear is made from soft fleece, and dressed in the clothing that is provided by you. Outfits are custom resized to fit your bear either exactly as the outfit you are providing, or remade into something entirely different. Bears are made in your choice of color (please select one):  ___White              ___Cream               ___Black                 ___Light Brown (beige-like)                  ___Dark Brown

                   ___Medium Brown             ___Other:____________________ (please check for availability of non-traditional colors)


____ Patchwork Memory Bear – Bear itself is made from various clothing items provided by you.



Eye Color for your Memory Bear: _______________________________  (if none indicated, bear will be made with brown eyes)


Embroidered Message:

A personalized message will be embroidered on the foot of your bear (One foot message is free of charge. Add other foot message for $5)

Message can be up to 12 characters per line (including spaces), and up to 4 lines. Please print your message(s):

Right Foot Message:                                                           Left Foot Message:




Please indicate details for your bear’s clothing, and any special requests you have.





A hat can be made for your Memory Bear for $12. Additional accessories, including belts, neck ties, eye glasses, etc., can be added for a small charge of $5 each.

Extra Material: There may be clothing material leftover after making your bear(s). Would you like the extra material returned to you?__________
**Please note: Additional postage will apply and is based on the amount of material.**

Order Totals:

Memory Bear       QTY_____ @ $75 ea.   _________                                                                  PAYMENT DETAILS:

Embroidery           QTY_____ @ $5 ea.     _________                                  _____ Check / Money Order Enclosed

Accessories           QTY_____ @ $5 ea.      _________

Hats                        QTY_____ @ $12 ea.    ________                                   _____ VISA  _____Master Card  _____ Discover  ____American Ex

Shipping & Handling: 1 Bear=$11.95                                                               Card #___________________________________________

Each additional add $2.00                           _________                                  Expiration Date____________         CCV#_______________

                                ORDER TOTAL               $________                                   Auth Signature for Credit Card purchase:                                                                  

If you are experiencing difficulty downloading our order form, copy the form below. We recommend copying and pasting into a word document and then printing to eliminate unwanted background clutter.

We recommend downloading our order form by clicking this link:

Original Memory Bears                        Patchwork Memory Bears

 Family owned and operated since 2006. Memory bears and quilts are hand crafted keepsakes from clothing to cherish memories and loved ones forever...