DOLL HOSPITAL ADMISSION FORM

Date
/
/
Name of doll’s owner
We’re admitting
Hair color
(Doll’s name)
Eye color
All repairs include complimentary wellness service. After repairs, dolls are returned with:
For 18" dolls—Certificate of Good Health • Doll Hospital Gown and Socks • Doll Hospital ID Bracelet • Get Well Card
For Bitty Baby™/Bitty Twins™ dolls—Certificate of Good Health • Doll Hospital Gown and Cap • Get Well Card
For WellieWishers™—Certificate of Good Health • Doll Hospital Gown and Socks • Get Well Card
A la carte services for ear piercing/hearing aid installation excludes wellness service and other items included with repairs.
Type of repair/service:
Admission form
Bill to:
Total price
USD:
18" AMERICAN GIRL DOLLS
REPAIRS
Adult name
New head (same American Girl only) $44
New body (torso and limbs) $44
New
torso
limbs
$28
Reattachment of $32
head
Address
$34
(choose one)
Eye replacement (same eye color only)
limbs
(choose one)
Wellness visit Skin cleaned, hair brushed, hospital gown,
and certificate, but no “major surgery” †
Apt/suite
Doll Hospital Admission Process
City
$28
State
Zip Code
Home telephone
SERVICES
Ear piercing
$16
Add hearing aid
$14
left
right
both
Cell
E-mail address
BITTY BABY & BITTY TWINS
$22
New body (torso and limbs)
$22
Eye replacement (same eye color only)
$18
Reattachment of head
$16
Wellness visit $18
Name
City
$18
New head & body (head, torso and limbs)
$44
Shipping & processing
Important information about your repair:
Address
WELLIEWISHERS
Wellness visit State
Zip Code
Comments:
If doll is to be shipped to an international address other
than Canada, please add $60.00.
$15
Next Day
$20
• Parts replaced through surgery will not be returned.
• We reserve the right to refuse repairs at any time for
any reason.
SUBTOTAL
We are required to collect applicable sales tax for deliveries to the following states:
AZ, CA, CO, FL, GA, IL, KS, MA, MN, MO, NC, OH, NY, SD, TN, TX, VA, WA, and WI.
TOTAL
Payment method: Invoice will be mailed to purchaser as order confirmation.
Enclose your personal check, money order, gift card, or credit card information as indicated below.
Make checks payable to American Girl.
Check/money order
MasterCard (16 digits)
Gift card (19 digits)
Discover/Novus (16 digits)
American Express (15 digits)
Visa (16 digits)
Credit card number
CID number or gift card PIN code
Expiration date
–
Year
• All replacements & attachments include skin cleaning &
hair brushing at no additional charge.
• Altered/unidentifiable dolls may not be accepted
SALES TAX
Month
† Wellness Visit skin-cleaning will remove most surface
dirt from your doll’s vinyl, but is not likely to remove
ink or dye stains. Wellness Visit hair-brushing will
improve the appearance of the doll’s hair, but will not
make a well-played-with doll’s hair look brand-new.
• Admission of a complete doll (head and body) is
required to purchase a new head or body.
$7.95 per doll
For US and its possessions
2-Day
W 1008
Ship to (if different from “bill to”):
Apt/suite
Skin cleaned, hair brushed, hospital gown,
and certificate, but no “major surgery” †
Place your undressed doll and admission form
with payment attached, including shipping
charges, in a sturdy box. Please do not wrap
your doll in newsprint. If sending more than one
doll, please complete a separate admission form
for each one. Tape the mailing label (above) to
your package to send your doll to the hospital
via a traceable method.
Doll will be shipped to address above unless an alternate address is given below.
New head (same Bitty Baby or Bitty Twin only)
Skin cleaned, hair brushed, hospital gown,
and certificate, but no “major surgery” †
DOLL HOSPITAL
8350 Fairway Place
Middleton, WI 53562
Please allow two to four weeks for repair.
To learn more about our Doll Hospital, visit americangirl.com.
®
Where your American Girl doll goes to get better!
Send to:
DOLL HOSPITAL ADMISSION FORM
DOLL
HOSPITAL
Clip and tape the mailing label to your package to send
your doll to the hospital via a traceable method.
®
Signature of authorized buyer