ORDER
Name:
Date:
Phone:
Shipping Address:
Pet’s Name(s):
HEARTGARD
GREEN
(25-50 lbs) $37.00 ___________ be available by mail. Call with
BROWN
(51-100 lbs) $45.00 ___________ any questions.
FRONTLINE
SMALL DOG (under 22 lbs) $47.00 ___________ **IMPORTANT**
MEDIUM DOG (23-44 lbs) $48.00 ___________ We must have seen your animal
LARGE DOG (45-88 lbs) $52.00 ___________ before
we can send out any
EX. LARGE DOG (89-132 lbs) $53.00 ___________ medication.
Countryside Animal Clinic
REVOLUTION (
SMALL (<5 lbs) 3 pack $48.00 ___________ N. Zulch,
TX 77872
REGULAR (5.1-15 lbs) (936) 399-6017
3 pack $48.00 ___________ (713) 492-8045
6
pack $80.00 ___________
COMFORTIS (flea
pill for Dogs only)
5 lbs- 10 lbs 3 mo $45.00 _______ 6
mo $84.00 _______
10.1 lbs- 20
lbs 3 mo $46.00 _______ 6
mo $86.00 _______
20.1
lbs- 40 lbs 3 mo $48.00 _______ 6
mo $88.00 _______
40.1
lbs- 60 lbs 3 mo $50.00 _______ 6 mo $90.00 _______
60.1 lbs- 120 lbs 3 mo $51.00 _______ 6
mo $92.00 _______
CIRCLE METHOD OF PAYMENT (DO NOT SEND
CHECK
(Include DL# on check) or MONEY ORDER ENCLOSED
VISA MASTERCARD DISCOVER
Last 3 digits of code on rear of card ______ bill mailing zip______
Signature____________________________________________
WE DO NOT AUTHORIZE ANY INTERNET
PHARMACY Rx.