E-Z KENNEL PLUS ORDER FORM (For orders within the U.S.)

CHAPMAN PET PROGRAMS

1951 Hwy 61

LORAINE, IL 62349

Ph:(217)696-2551

Fax:(217)696-2802

E-Mail:askme@ezkennel.com

You may print, complete and fax back, snail mail it or copy and paste information into an e-mail message to us to place your order. Also if you prefer you may call us to place the order.

____$140.00, E-Z KENNEL PLUS v.6, New Customer Price(One PC)

$135+$5(S&H)= $140.00. (If installing on a home network you may purchase a Network Station License for each additional PC on the network. Call for Details.)

____$75.00, E-Z KENNEL PLUS v.6, Upgrade from a previous version

$70.00+$5.00(S&H)=$75.00 Must be a Registered User.

* = Required Fields

Business Name:

*First Name:

*Last Name:

*Address:

*City: *State: *Zip:

*Phone:( ) Fax:( )

E-Mail:

Method of Pmt: _____Money Order _____Check#:__________ (Allow 3-5 weeks for check orders)

By Credit Card (All fields below required.) _____Visa _____Discover _____MasterCard

Credit Card # :____________--____________--____________--____________

Exp. Date:_____/_____ Last 3 Digits on Back of Card: __ __ __

Name of Cardholder:

Card is Billed to: Address:

City, State, Zip:

If you have questions or special needs please contact us before placing your order.