E-Z STABLE ORDER FORM
(For orders within the U.S. only)

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,
mail or copy and paste information 
into an e-mail message to us.

E-Z STABLE STANDARD
PRICE:$125+$7(S&H)= $132.00 (ONE PC)

E-Z STABLE PLUS
PRICE:$175+$7(S&H)= $182.00 (ONE PC)

If installing on multiple PCs on a network
Add $50.00 for each additional Network Station.

NETWORK STATIONS:____ X $50.00=$_________

PRICE + NETWORK STATIONS = TOTAL:$__________


FIRST NAME:
LAST NAME:
BUSINESS NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX:
E-MAIL:
METHOD OF PAYMENT:
TYPE OF CARD:
(We accept: Visa, Discover or MasterCard)
CARD NUMBER:
EXP. DATE:
LAST 3 DIGITS OF NUMBER ON 
BACK OF CARD (IN SIGNATURE AREA):
NAME OF CARDHOLDER:
ADDRESS OF CARDHOLDER:
SIGNATURE(if faxing or mailing):