To order, print this form, complete and mail to:
Adoption World Specialties Ltd.
Dept. I-N
6920 Wilton Dr. NE
Cedar Rapids, IA 52402

Name: _______________________________________________

Agency: _____________________________________________

Address: ____________________________________________

City: _________________________________________________

State: _________________    Zip:_________________________

Phone: (        )_________________________________________

Fax: (        )____________________________________________

E-Mail: _______________________________________________

Quantity_____________ @ $10.95 = $______________________

Iowa Residents add 5%       $_________________
(6% if local option tax applies)

Thank you for ordering.....

Please e-mail or call our sales department at (319) 365-3454 for further questions.
For orders outside the U.S., please contact us at (319) 365-3454 or by e-mail before ordering.

All prices and shipping rates are subject to change.