| Contact Information |
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| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| First Name: |
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| Middle Name or Initial: |
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| Last Name: |
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| Birthday: |
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| Time: |
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| Weight |
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| Pounds: |
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| Onces: |
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| Length: |
Inches |
| Place of Birth: |
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| City: |
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| State: |
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| E-mailing Baby Photo |
Please e-mail the image at 300 dpi to slee@babybirthcertificate.com with your baby's first and last name in the subject line. |
Mailing Baby Photo |
If Mailing your baby photo: Mail to: Ten Tiny Fingers ATTN: (Your Baby's First and Last Name) P.O. Box 12688 Fort Wayne, IN 46864-2688 |
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| Genealogy |
The Information below will appear on the certificate as submitted |
| Mother |
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| First Name: |
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| Middle Name: |
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| Maiden Last Name: |
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| Father |
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| First Name: |
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| Middle Name: |
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| Last Name: |
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| Maternal Grandmother |
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| First Name: |
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| Middle Name: |
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| Maiden Last Name: |
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| Maternal Grandfather |
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| First Name: |
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| Middle Name: |
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| Last Name: |
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| Paternal Grandmother |
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| First Name: |
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| Middle Name: |
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| Last Name: |
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| Paternal Grandfather |
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| First Name: |
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| Middle Name: |
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| Last Name: |
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| Purchasing Information |
Click on the package you want to purchase. |
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Single Baby |
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Adopted Baby |
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*Please select only one. |
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Package #2 |
$39.95 |
1: |
11x14 Parents |
2: |
8x10 Grandparents |
8: |
3x5 Announcements |
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| Select Paper Type: |
Ivory |
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Parchment |
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*Please selct only one. |
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| Delivery: |
Please allow 4 to 6 weeks for delivery |
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NOTE: |
Gift Certificate purchases are not available through this online option. Please return to the previous page and print off the order form for "Pay by Check, Money Order, and/or Gift Certificate". |