| Adult Memory Blanket Instructions and Order Form |
| Name |
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| Street Address |
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| City/State/Zip |
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| Home Phone |
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| Email address |
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| How did you hear about us? |
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| Blanket Size 48" x 48" = $125 60" x 72" = $240 |
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| Fabric for back of blanket |
white striped chenille or cream striped chenille |
| Monogram up to 9 letters (add $6.00) |
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| Total Amount Enclosed (add $8.50 per blanket for shipping) |


| Baby |