Birthday Choice Application Form

Information

Birth place:

Husband:

Birthday *
( If was born abroad, please fill in foreign time )

Birth place:

Wife:

Birthday *
( If was born abroad, please fill in foreign time )

Birth place:

Fetal Info:

The Fetus　B-ultrasound jerque Fetal Sex *

Pregnancy:

Estimates of birth:

Remark:

Contact Information

Contact person:

Address:

Tel:

Mobile:

Email:

Remittance:

Bank:

Currency *

Remittance date

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Please carefully check the contents:

Birth place:
Husband:　　
Birth place:
Wife:　　
Birth place:
Fetal Info:The Fetus　　B-ultrasound:　Fetal Sex:
Pregnancy:　
Estimates of birth：　

Remark:

Contact person: Address:
Tel: Mobile: Email:
Remittance: Currency: Bank:
Discount amount: RMB

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