Your information:

Please print out this whole page, fill out the bottom, and send it back to us by mail or fax at 780.452.7262 as soon as possible. Receipts are available upon request.

Our mailing address is:

Grand Paws
12510 128 Street,
Edmonton AB
T5L 1C8

Name _______________________________________________________________________________

Address _____________________________________________________________________________

_____________________________________________________________________________________

Home Phone (       ) ___________________________________________________________________ 

Work/Cell Phone (       ) ________________________________________________________________

Email _______________________________________________________________________________

Credit Card:   Visa      MasterCard    American Express

Name as it appears on card _____________________________________________________________

Card Number: ______________________________________________exp date:___/___

Security Code:___________________________________________________

Signature of card holder:___________________________________________________

Do you need a receipt?  Yes____    No ____