BUSY BEE PILLOW ORDER FORM

Please download and complete order form and mail to P.O. Box 917 Duncan, South Carolina, 29334; or fax to 864-439-5300; or scan email to . Payments made via PayPal to or mail a check to above P.O. Box. All orders will be processed upon receiving payment.

Customer Name & email: / QUANTITY:
Delivery Street Address: / TOTAL: / $130.00 Each Pillow Includes Carry Bag
City, State, Zip: / Monogrammed:

CustomizablePillow(NOTE: Please use separate order form for each pillow ordered)

Pillow Slip Cover Color (Circle One)

  1. Red
  2. Orange
  3. Yellow
  4. White
  5. Woodland Camo
  6. Coral Green

Fabric Topper – Top of Pillow (Circle One)

  1. Variety of Bumble bee’s
  2. Purple Alzheimer’s Ribbon
  1. Sports Theme
  2. Mermaid Sequins
  3. Therapeutic Pillow Topper (red)
  4. Kitties
  5. Puppies
  6. Faux Fur
  7. Sewing Fun
  8. Happy Birthday
  9. Spring Butterflies and Roses
  10. Valentine’s Day

13.St. Patrick’s Day

14. Santa Clause -continues next page-

Choose your aromatherapy scent (Choose 1)

  1. Fall Leaves 1. Lavender Tranquility

16. Halloween 2. Peppermint

(we can customize a topper for a special 3. Seaside Oasis

Holiday or hobby) 4. Vanilla Orchid

Special request:______5. Beach Getaway

6. Coconut Milk & Patchouli

Individual item price, please see andcheck next to item wanted & circle above for choice options when buying individual parts of the Busy Bee Pillow.

Example: Some people only want the lap pillow with the blanket, so a user can color or work a crossword puzzle etc. Also fill this out if you are re-buying for your Busy Bee Pillow to change out an attachment or pillow topper to keep the user oriented to place and time. Remember the user will never get board because you can change out attachments to keep the user busy and these attachments are great for range or motion, hand strengthening, eye coordination and all locked down for safety. Also, some senior facilities buy more than one blanket to switch from user to user in a day. Please note all items are detachable for easy cleaning.

__Busy Bee pillow lap pillow with pillow cover & choice of blanket(circle pillow cover choice & blanket color above) $50.00

____Topper- $25.00 (circle topper choice above) ____ Aromatherapy refill $9.00 (circle scent above)

___Set of 3 keys- $5.00 ___Tic-tac-toe-$15.00

___Pocket watch-$12.00 ___Water bead mat-$15.00 (for coloring sorting)

___Fidget Parachute clip-$5.00 ALL DETACHABLE BLANKETS $15.00

___Fidget Bee Hive-$10.00 ___Purple ___Red

___Photo Album (hold 6 pictures) $8.00 ___Yellow

___Recordable voice box-$20.00 (3min song or voice message-Take 3 AAbatteries) ___Pink

___Fidget/therapy tennis ball on rope-$10.00 (designed for range of motion) ___Green

___Fidget/therapy emoji squeeze ball-$7.00 (designed to build hand muscles) ___ Brown

___Fidget/therapy button snap/unsnap-$5.00 ___Black

___Fidget/therapy Velcro strip- $5.00 ____Orange

___Fidget Textile square cloth- $5.00 ___Burgundy

___Honey Bee maze-$15.00 ___Blue

___Smiley face maze-$15.00

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WARNING: Chocking Hazard- SMALL PARTS. All pillow attachments should never be left alone with anyone living with Alzheimer’s or Dementia or small children. Small parts are dangerous and can be chocked on.

Thank you for your order

Questions please call Misty @ 864-804-7148

Email:

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