Promotees Secure Canine Order Form

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Or Fillout & Print. Fax:(540-785-4390) Mail: Promo Tees & Designs, POB 41952, Fredericksburg, VA 22404


Enter Breed: Dog breeds
Optional Size CategoryGiant Miniature Standard Toy
This Pet is:Purebred a Mix
Dog's Common Name:
Owner's Name: Examples: the Smiths, Karen James, The Brown Family
This Dog is:Kennel Club Registered Unregistered
If registered: Dog's Registered Name:
Select a Owned by Caption: * suitable for Deceased Pet
Select a quote: If mailing write quote # in box do the same for the Caption box above
Certificate Layout:Portrait Landscape See a PORTRAIT and LANDSCAPE layout
Certificate Version:Photo Cutout No cutout See Examples

Select a border type: See available BORDERS
Name:
E-Mail:
Company:
Street Address:
City, State, Zip: ,
Phone:
Select your Product(s) here:
Comments:
Payment Type MasterCard Visa Amex Discover
Credit Card number exp:
CVS Code
CVV2 Code: 
The CVV2 code is the last 3-digits See Example on back of credit card or the small 4-digits See Example on front of am. express card)