Order Form

The Bednarcik's Personalized Book Order Form.

Please use separate order form for each book

Pick only 1 Book (Either 1 licensed, 1 non-licensed, OR 1 Religious Book)  Leave other 2 fields on BLANK

Licensed Book: $11.00
Non-Licensed Book: $9.00
Religious Book: $9.00
Child's First Name:
Middle Name (Optional):
Last Name:
State :
Boy / Girl: Boy Girl
Up to Three Friends or Relatives:  
Dedication #1:
This Book Is From:
Dedication #2:

Dedication #1 can be anything like: "With All Our Love", "Happy Birthday Jack", "Merry Christmas", "Hope to See You Soon", etc.
This Book is From can be anything like: "From Mommy and Daddy", "From Santa", "From Grandma", "From Jack and Cindy", etc.
Dedication #2 can be anything like: "May 29th, 2003", "December 25, 2004", "We Love You Very Much", "Go Cubbies", etc.

If you are ordering "NFL Super Bowl Book " please complete the following information. If you are NOT ordering either of these please click here to skip this section.

Favorite Player:
Winning Team:
Losing Team:

If you are ordering "School is Fun" and would like to include the child's teacher and school in the story, please complete this information. If you are NOT ordering "School is Fun" please click here to skip this section.


Shipping address  

Zip Code:
Daytime Phone Number:
Evening Phone Number:
E-Mail address:

Prices in U.S. Dollars for shipping within the U.S.

Please e-mail us for prices to ship Internationally

Please allow 2 weeks for delivery

Shipping Charges:
Please add $2.00 per book to cover shipping and Handling

Total Amount of Order:
Payment Method:Check Money Order PayPal (Click Icon)

Please make all checks & money orders payable to 

John Bednarcik
522 Truman Annex  Apt. B
Key West, FL.  33040

  I accept payment through PayPal!, the #1 online payment service!


If the SUBMIT button DOES NOT work, then please:  Once Completed, highlighted everything on the page and click EDIT, COPY (CTRL C).  Then create an e-mail message and in the body of the message, click EDIT, PASTE (CTRL V).  Send E-mail to:  Books1@Bednarcik.com 


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