Canine Travel Size First Aid Kit order form
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Is this a gift? (We won't include the receipt if it is)
Address for delivery (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of kits ordered
*
1
2
3
4
5
6
7
8
9
10
Kits are $29.99 each - tax and shipping included - Enter total below:
*
Method of Payment
*
Visa
Mastercard
Etransfer (to info@caninehealthcanada.com)
If paying by cc please enter the first 8 digits below:
Enter the last 8 digits here:
Expiry
CCV
Other instructions/comments:
Please verify that you are human
*
Submit
Should be Empty: