We need the following information and $150 deposit to begin service. If you prefer, you may download our New Customer form here.
New Customer Set-Up Information
Name:
______________________________
Partner’s Name:
_______________________
Delivery Address:
______________________
Billing Name and Address (if
different): _______
___________________________________
Phone Number/s:
______________________
E-mail address: ________________________
Baby’s Due Date OR Age and
Weight: _________
How did you find out about us? ______________
How did you find out about us? ______________
Starter
Amounts (your “count”) –
circle one in each category:
circle one in each category:
Diapers
Number of Rental Diapers per week:
(standard starter amount is 80 diapers):
(standard starter amount is 80 diapers):
20–30–40–50–60–70–80–90–100–120–130–140
Diaper Size: (standard starter size
is x-small)
x-small (4-9#) – small(10-15#) –
medium(16-25#) – large(26-35#) – x-large(36#+)
Diaper Covers
Number of Rental Covers per week:
(standard starter amount is 7)
(standard starter amount is 7)
5 – 6 –
7 – 8 – 9 – 10 – 11 – 12 – 13 – 14 – 15
Cover Size:
x-small (4-9#) – small(10-14#) –
intermediate (15-17#) - medium(18-25#)
Please see our website for purchasing new or used covers.
Diaper
Hamper yes no Zinc-Free
Balm yes no
