First & Last Name:
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EMAIL Address:
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BILLING ADDRESS:
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CITY
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STATE:
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ZIP CODE:
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PHONE NUMBER:
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CREDIT CARD NUMBER:
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MUST BE COMPLETED TO PROCESS ORDER
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VALIDATION CODE:
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{VALIDATION CODE is: 3 numbers found on reverse of card after account number }
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EXPIRATION DATE:
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FABRIC choice
for 1 Cover:
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* IF ORDERING MORE THAN 1 Cover Fill in CHOICES BELOW!*
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Fabric Choice for Cover #2:
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Fabric choice for Cover #3:
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Fabric choice for Cover #4:
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CUSTOMIZE MY COVER WITH OPTIONS {Check all that apply}
NOTE**If ordering Second or Third cover type additional options in comments below*
{example: Cover 2 polo sport add deluxe and denim}
ADD Denim Underside $12.99
ADD Deluxe
2 extra pockets & 1 extra toy loop $5.99
ADD Flip Flop/Reversible
{2 covers in 1 seamless}
Print on one side Solid with 1 pocket &
1 Loop on other $12.99
ADD A Matching Pillow $10.99
Denim/Toile/Character $11.99
ADD Safety Belt Snap Hook $4.00
**Specify Cover STYLE BELOW**
Single Cover 4 Kids
Double Cover 4 Kids
Double/Single Cover with flaps
Shipping Address if different than above:
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Any comments?
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