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First Name *

Last Name *

Address *

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State *

Zip *

Dog Name/s *

Dog/s breed *

Vaccinations & Worming Current? *

Temperament? *

Order notes (optional)

Product	Subtotal
De Stink Treatment × 1	$18.00
Dog Poo Pick Up Service × 1	$23.00
Subtotal	$41.00
Shipping	Enter your address to view shipping options.
Total	$41.00

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