Puppy Stuff 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.

Puppy Stuff
PRICE:$230+$7(S&H)= $237.00


OWNER'S FIRST NAME:
OWNER'S LAST NAME:
STORE 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):