Memory Bears and More, Inc.
3129 State Road
Ashtabula, OH 44004
Phone: 440-998-7178 Email: firstname.lastname@example.org
MEMORY BEAR / PATCHWORK BEAR ORDER FORM
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.
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)
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.**
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