The Canine Clubhaus Customer American Kennel Club
Owner Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
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-
Area Code
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Email
example@example.com
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Who were you referred by?
Occupation
Dog Information
Dog's Name
Breed
Age
Spay / Neutered?
Yes
No
Veterinarian
Medical Problems/meds/allergies
Form Info
Method of Payment
Paypal (send payment to manuela@thecanineclubhaus.com )
Credit Card (pay now)
Are you looking for the test only or the 6-week class and test?
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next
( X )
American Kennel Club 6 Week Class & Test
$
300.00
American Kennel Club Test ONLY
$
25.00
Total
$
0.00
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