Dog's Name: ____________________
Breed: ____________________
Date:____________________

Article Set Size* (Small, Med, Lg...): ____________________

Dumbbell Size (Small, Med, Lg...): ____________________

Custom Dumbbell Size:
       Dowel Diameter: __________
       Dowel Length: __________
       Bell Size: __________

Request Ready By: ____________________

Owner’s Name: ______________________________
Address: ______________________________

Phone Number: ____________________
Email Address: ____________________

Please tell us how you heard of our company: ______________________________

Date: __________
Check #: __________
Amount: __________
    Tax (in South Carolina only - .06%):
    Shipping & Handling
    ($15.00 for article set or $7.50 for dumbbell): __________
                                                   Total: __________
Signature: _________________________