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PRICES GOOD THROUGH July 1, 2008

ORDER FORM

FREE SHIPPING!

Name________________ Shipping Address:

Phone________________ _______________________

_______________________

Pet’s Name________________________ Date__________

HEARTGARD PLUS (6 PACKS) QUANTITY ORDERED

BLUE (under 25 lbs) $26.00 ___________

GREEN (25-50 lbs) $34.00 ___________

BROWN (51-100 lbs) $43.00 ___________

FRONTLINE PLUS (3 PACKS) **IMPORTANT**

SMALL DOG (under 22 lbs) $45.00 ___________ We must have seen your animal

MEDIUM DOG (23-44 lbs) $47.00 ___________ before we can send out any

LARGE DOG (45-88 lbs) $50.00 ___________ medication.

EX. LARGE DOG (89-132 lbs) $51.00 ___________ MAIL OR CALL:

CAT $44.00 ___________ Countryside Animal Clinic

P.O. Box 356

REVOLUTION (CATS) N. Zulch, TX 77872

SMALL (<5 lbs) 3 pack $45.00 ___________ (936) 399-6017

REGULAR (5.1-15 lbs) (713) 492-8045

3 pack $45.00 ___________

6 pack $76.00 ___________

COMFORTIS (flea pill for Dogs only) (6 months) Refills of other medications may

5 lbs- 10 lbs $80.00 __________ be available by mail. Call with

10.1 lbs- 20 lbs $82.00 __________ any questions.

20.1 lbs- 40 lbs $84.00 __________

40.1 lbs- 60 lbs $86.00 __________

60.1 lbs- 120 lbs $88.00 __________

CIRCLE METHOD OF PAYMENT (DO NOT SEND CASH)

CHECK (Include DL# on check) or MONEY ORDER ENCLOSED

VISA MASTERCARD DISCOVER

CARD # ___________________________expiration__________

Last 3 digits of code on rear of card______ bill mailing zip______

Signature____________________________________________

WE DO NOT AUTHORIZE ANY INTERNET PHARMACY Rx.