CANADA DOLL HOSPITAL

ADMISSION FORM ®

Where your American Girl doll goes to get better! ®

Please allow two to four weeks for repairs. Add an extra week for One of a Kind doll repairs. To learn more about our Doll Hospital, visit americangirl.com.

Date / / Name of doll’s owner

We’re admitting Hair color Eye color DOLL HOSPITAL 8350 Fairway Place Fairway 8350

(Doll’s name) WI 53562 Middleton, United States of America States United 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 method. a traceable via the hospital doll to your Clip and tape the mailing label to your package to send send to package your to the mailing label Clip and tape

For WellieWishers™ dolls—Certificate of Good Health • Doll Hospital Gown and Socks • Get Well Card Send to: A la carte service for ear piercing/hearing aid installation excludes wellness service and other items included with repairs.

Type of repair or service: Admission form Doll Hospital Admission Process

18" AMERICAN GIRL DOLLS Total price USD: Bill to: Place your undressed doll and admission REPAIRS form with payment attached, including Adult name ______New head (same American Girl doll only) $44 shipping charges, in a sturdy box. Please do not wrap your doll in newsprint. New body (torso and limbs) $44 Address ______If sending more than one doll, please New torso limbs (choose one) $34 complete a separate admission form for Apt/Suite______Eye replacement (same eye color only) $28 each one. Tape the mailing label (above)

Reattachment of head limbs (choose one) $32 City ______to your package to send your doll to the hospital via a traceable method. Wellness visit † $28 Skin cleaned, hair brushed, hospital gown and certificate, but no “major surgery” State ______Zip ______SERVICES Important information about your repair: Home telephone ( ) ______Ear piercing $16 † Wellness Visit skin-cleaning will remove $14 most surface dirt from your doll’s vinyl, but Hearing aid Left Right Both Cell ( ) ______is not likely to remove ink or dye stains. BITTY BABY™ & BITTY TWINS™ E-mail address ______Wellness Visit hair-brushing will improve New head (same Bitty Baby or Bitty Twin only) $22 the appearance of the doll’s hair, but will Doll will be shipped to “bill to” address above unless an alternate address is given below. New body (torso and limbs) $22 not make a well-played-with doll’s hair look Eye replacement (same eye color only) $18 brand-new. Ship to (if different from “bill to”): Reattachment of head $16 • All replacements & attachments include skin Adult name ______cleaning & hair brushing at no additional Wellness visit † $18 Skin cleaned, hair brushed, hospital gown and certificate, but no “major surgery” charge. Address ______• Admission of a complete doll (head and WELLIEWISHERS™ body) is required to purchase a new head Wellness visit † Apt/Suite______or body. Skin cleaned, hair brushed, hospital gown and certificate, but no “major surgery” $18 • Altered/unidentifiable dolls may not be New head & body (head, torso and limbs) $44 City ______accepted Ear piercing $16 • Parts replaced through surgery will not be Subtotal State ______Zip ______returned. • We reserve the right to refuse repairs at any Add 12% of SUBTOTAL for Canada Delivery Fees* Home telephone ( ) ______Shipping & Processing to Canada $7.95 per doll time for any reason. Express Shipment to Canada + $10.00 per doll Cell ( ) ______• Shipping and processing fees are non- Total refundable. * Canada delivery fees include costs paid to a customs E-mail address ______broker, enabling delivery to your door. All prices in US currency.

Payment method: Invoice will be mailed to purchaser as order confirmation. Comments: 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 – Month Year Signature of authorized buyer