PLEASE PRINT                          DATE________

PAT'S PETS                                        NAME____________________
4189 JARVIS RD
HILLSBORO,MO63050                   SHIP TO:    STREET____________________

MINIMUM TOTAL ORDER $20                           CITY____________________

PHONE__________________E-MAIL___________________ STATE_____ZIP____________

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                                                         SUBTOTAL_________

                                             PACKING AND SHIPPING_________

                                MISSOURI RESIDENTS ADD 5.725% TAX_________

                                                            TOTAL_________