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Muffin's
Discount Spay/Neuter Application
APPLICATION (Do Not Bring to Vet)
PRINT NAME ————————————————————————————
ADDRESS ———————————————————————APT————
CITY —————————————————STATE——————ZIP————
PHONE (
)——————————— PAYMENT: Money Order $_____
Make Money Orders payable
to:
Lassow-MUFFIN’S PC
310 - 94th Street, Apt. 525, Brooklyn, NY
11209-7742
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 $ —————
Please charge to VISA/MC, Discover or Amex $
———————————
RUSH
ORDERS: Call (718) 833-7988
___________- ___________-___________- ___________ Exp. Date _________
Signature
____________________________________________
Date_________________________________________________
Referred
by___________________________________________
VET'S EMAIL ADDRESS REQUIRED: _________________________________________
NAME OF THE VETS OFFICE: __________________________________
NAME OF THE PET: __________________________________________
DATE OF APPOINTMENT: ________________________________________________
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