CITY: STATE: ZIP:
Provide Your Email Address to Activate Your Online Membership Rewards:
Redeem member discounts for online orders and receive customer service emails regarding your account / orders.
What animals do you care for? (check all that apply)
___Dogs __Cats ___Birds ___Wildlife
Which service(s) do you provide? (check all that apply)
___Shelter __Rescue ___Humane Society
SIGNATURE ___________________________ Date____/____/______
Tax Exempt Organizations: Please be sure to include a copy of your certification with your application.