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New Customer Service Agreement Form
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone
*
Email
*
How many dogs do you have?
*
Dog Waste Removal Service
*
Once a week
Twice a week
Every other week
One-Time Cleaning
Day/Time preference for service
*
Breed of Dog(s):
*
Name of Dog(s):
*
Briefly describe your dog(s) temperament:
*
List any special Instructions for dog(s) and entering your property
*
Will your dogs be outside during service?
*
Yes
No
Sometimes
Where would you like Poop Rescues to donate?
*
ASPCA or the Rescue League/Shelter of the month (from time to time we would like to donate to a local rescue league or shelter that has not been selected)
Rescue League
Shelter
If you selected Rescue League or Shelter, please provide the name below
*
How do you prefer to pay your bill?
*
Check
Visa
Mastercard
Amex
Discover
PayPal
Cash
Would you like to have your invoice e-mailed or mailed to you?
*
E-mailed
Mail
Please note: If you select a credit card, you will be e-mailed an invoice through PayPal but you do not need a PayPal account to pay.
Would you like to subscribe to our newsletter? We offer discounts from time to time.
*
Yes
No
I give Poop Rescues, LLC Permission to come onto my property on service days.
I have read the
Billing Terms & Policies
I am aware that if I want to cancel a service day, that I need to call Poop Rescues at least one day in advance.
Electronic Signature
*
Submit
One other thing... we would love a picture of your dog(s) for the "Our Friends" section of our website. Please send any pictures to
vita@pooprescues.com
.