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Muffin's Discount Spay/Neuter Application

APPLICATION (Do Not Bring to Vet)

PRINT NAME 覧覧覧覧覧覧覧覧覧覧覧覧覧覧

ADDRESS 覧覧覧覧覧覧覧覧覧覧覧輸PT覧覧

CITY 覧覧覧覧覧覧覧覧祐TATE覧覧覧ZIP覧覧

PHONE (     )覧覧覧覧覧 PAYMENT: Money Order or *check $_____ 
(*put phone # on check)

Make Checks or Money Orders payable to: 
MUFFIN担 PC
9728-3rd AVE. B125, Brooklyn, NY 11209-7742


Fax order 8am - 8pm   
(718) 921-6327

On a charge or Money Order: If you would like the certificate faxed to the vet, please tell the vet that Muffin's will fax certificate, that you need an appointment.  Then make a note on this application stating: vets office, date of appointment and pets name.  *For dogs, the first 30lbs.  Additional fees for extra anesthesia paid to the vet.
Thank you.

Jude, Director
   
                                            
PLEASE CIRCLE ONE:

CAT: Male  $50 X =         *DOG: Male  $65 X---- = -----

CAT: Female  $65 X =     *DOG: Female  $85 X ----= ----

GRAND TOTAL $ 覧覧

Please charge to VISA/MC, Discover or Amex $ 覧覧覧覧覧          
RUSH ORDERS:  Call (718) 833-7988 or fax credit card info to 
(718) 921-632

___________- ___________-___________- ___________ Exp. Date _________

Signature ____________________________________________
Date___________________Pets Name_____________________
Referred by___________________________________________

*
CERTIFICATE TO BE FAXED TO VET:

NAME OF THE VETS OFFICE: __________________________________
NAME OF THE PET: __________________________________________
DATE OF APPOINTMENT: _
_______________________________________________