PUPPY STUFF ORDER FORM (For orders within the U.S.)

CHAPMAN PET PROGRAMS - 1951 Hwy 61 - LORAINE, IL 62349

Phone:(217)696-2551 - Fax:(217)696-2802 - E-Mail:askme@ezkennel.com

You may print, complete and fax back, snail mail or scan & attach to an e-mail to place your order.

PLEASE SELECT (X) THE ITEM(S) YOU WISH TO ORDER

____$240.00, PUPPY STUFF New Customer Price(One PC)$230+$10(S&H)= $240.00. (If installing on

a network you must purchase a Network Station License for each additional PC on the network.)

____$50.00 Network Station License

____$75.00 each Additional Location

____$20.00 DEMO CD (allows 10 uses of the full program within 10 days of installation. If you decide to

purchase the program you just pay the balance of $220.00 for the full program to get your registration code)

____$20.00 Replacement CD

____$5.00 Priority Mail (All orders are sent First Class Mail unless the additional $5.00 for priority mail is

selected.)

* = 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:

*Total Amount (from above) to be charged: $________ . ____

I understand that all software purchases are final. This software is non-refundable and non-transferable.

*Actual Written Signature (required):____________________________________________________

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