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Print it out, _ Fill it out, _ Fax it Back

Pet-iD......... FAX 507-282-0027

Pet*iD WEB ORDER FORM - BILLING INFORMATION

First Name:

Last Name:

Address:

City

State

Zip

Home Phone:

Work Phone:

E-Mail Address:

Credit Card Type: (Circle One)

Visa __ MasterCard __ Ducover __Am. Exp

Card Number_____ Exp.: mo.___ Year ______

______________________________________________________

Card Holder's Name as it appears on your card:

ORDER INFORMATION..................... For Block Orders : Call (507) 282-4760

All orders are shipped within two working days