Quilt Order Form
Please fill out the following information and either mail it or e-mail it to us at the address below.
| Name: | ____________________________ | |
| Street Address: | ____________________________ | |
| City: | ____________________________ | |
| State: | ____________________________ | |
| Zip Code: | ____________________________ | |
| Telephone Number: | ____________________________ | |
| E-Mail Address: | ____________________________ | |
| Child's Name in English: | ____________________________ | |
| Child's Name in Chinese*: | ____________________________ | |
| Child's Date of Birth: | ____________________________ | |
| Name of Orphanage: | ____________________________ | |
| Province of Orphanage: | ____________________________ | |
| Quantity: | ____________________________ | |
| Amount Enclosed: | ____________________________ |
| * Please include a copy of your daughter’s adoption certificate or copy of passport showing her name in Chinese characters. |
P.O. Box 271333
West Hartford, CT 06127
Toll-free: 1-866-666-6520
(860) 523-9797