Amputeddy Order Form

Amputeddy.com Amputeddy Order Form

First Name Last Name

Street Address City

State Zip Daytime Phone- ext

Order Entry See Order Information for details
Amputeddy - Arm / Right		Standard @ $49.95 Total $
Amputeddy - Arm / Left		Custom @ $69.95 Total $
Amputeddy - Leg / Right		Special Set of 4 @ $159.95 Total $
Amputeddy - Leg / Left		Books @ $6.95 Total $
Amputeddy - Custom		Book Sets (1 of each) @ $18.00 Total $
Amputeddy - Professional Set (4 bears)		Sub Total $
Book Set (1 of each book)		Sales Tax (WA Residents only, see below) $
Book: Amputeddy Goes Back To School		Shipping & Handling $
Book: Amputeddy Meets Nubby Bear		Total $
Book: Amputeddy Helps A Friend

If you are ordering a Custom Amputeddy, please type a description below. You might include information about degree of amputation, multiple affected limbs, decorations, etc. If you want to submit drawings, sketches, etc, mail them to the address below. You can compose your message in Word or Notepad, and copy/paste it in.
Type or copy/paste your Custom Amputeddy description here

1. Check if shipping to Washington. (Adds sales tax)

2. Select payment type:

Click on the PayPal logo to pay or to learn more.

The recipient's email is jean@amputeddy.com

Print this page using your browser's print function and send

it to the address at the right, with check, money order,

etc, payable to Amputeddy, Inc.

3. Click on the Submit Order button to email the information on this form to Amputeddy, Inc.

All funds U.S. dollars

Jean Boelter, President

Amputeddy, Inc.

10332 Aqua Way S.

Seattle, WA 98168

jean@amputeddy.com

Amputeddy

does not

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