Address________________________________________
City, State, Zip___________________________________
Day Phone(with Area Code)________________________________________
Evening Phone(with Area Code)____________________________________
Best time to call?__________________________________
Email________________________________________
Shipping Address
(if different)_________________________________________________
City, State, Zip_________________________________
Sex: Male Female
Pet's Age __________________________
Weight (pounds) ___________________
Breed (For build; i.e. German Shepard/Lab mix)_____________________________
Cause of Disability ____________________________________
Date/Onset Disability ________________________________
Strong in the front legs? Yes No
Any use of rear legs? Yes No
Spinal Surgery? Yes No
(If yes, include date of surgery) ________________________________________
*Activity Level
(Before disability) Extreme Moderate Mild Inactive
*Pet's regular activities
_______________________________________________
*Does your pet get regular exercise? Yes No
*Terrain pet plays on regularly (grass, trails, sand, snow, etc.)_________________________________________________________________
may have to maximize the benefits of using our products.
Front Wheel Drive Wheelchair: $__________
All Wheel Drive Quad Chair: $__________
Front Extensions: $__________
Rear Saddle Support Sling: $__________
Front Saddle Support Sling: $__________
Belly Strap: $__________
Front Leg Splint: $__________
Rear Leg Splint: $__________
Paw Protectors: $__________
Doggie Diaper: $__________
Male Wraps: $__________
Show Foot Spray: $__________
SUB-TOTAL: $__________
Shipping: $__________
TOTAL: $__________
We accept:
American Express, Mastercard, Visa, Certified Checks, Money Orders or Wire Transfers
Credit Card Number: ________________________________________
Expiration Date: ________________________________________
Print Name on Card: ________________________________________
* Signature ________________________________________
*Your signature indicates you have read and agree to Doggon' Wheels returns and refunds policies.
Saddle Supports, Belly Straps, Paw Protectors, Splints, Diapers:
Nonrefundable once worn. If an exchange is needed contact Doggon' Wheels within 5 days of receiving the item.
Wheelchairs, Quad Chairs, Front Extensions:
30 Day Trial Period; 70% refund not including shipping. Must be returned clean and undamaged (other than normal wear from use)
- Top of Back at Hips to Floor _______________
- Top of Back at Shoulders to Floor _______________
- Length from Back of Front Leg to Back of Rear Leg (Elbow to Rump) _______________
- *Chest Girth behind Front Legs _______________
- *Girth of Upper Thigh _______________
- Width of Body at Hips _______________
- Width of Body at Shoulders _______________
- * Girth of Abdomen _______________
- * Girth of Upper Front Leg _______________
- * Width Between Armpits _______________
1, 2, 3, 6, 7 & 10 are measured in a straight line; 4, 5, 8 & 9 are measured around a body part in a complete circle.
INCLUDE ALL 10 MEASUREMENTS IF ORDERING A WHEELCHAIR,
QUAD CHAIR OR FRONT-END EXTENSIONS
Have someone help you so that pet can be assisted into a standing position for taking measurements. Pet must be assisted into a standing position for accurate measurements. Measurements are most accurate when pet is in a normal stance bearing partial weight. If using a soft measuring tape be sure to hold it taut when taking height, length and width measurements.
For #6 and #7 place two objects (like yardsticks, rulers, broom handle etc) on either side of the body at hips (shoulders) so that the object is touching pet and floor and is straight up and down, have someone measure the distance between objects in a straight line.
Do not increase this measurement as its important to be accurate for a great fit.
Use straight lines, except for #4, 5, 8 and 9- these should be taken snugly
like how you would measure your own waist.
#4 is basically the "bust"; #8 is the "waist". We will call you if any measurements need to be retaken.
- Three Ways to Use This Form
- Mail with your check or money order to:
Doggon' Wheels Orders
115 Commercial Drive, Unit A
Bozeman, MT 59715 - Fax your order 24 hours a day to:
1-888-2-DOGFAX (236-4329) or 406-522-0188 - Phone order during office hours to:
1-888-7-DOGGON (736-4466) or 406-522-1510
1-888-736-4466 (406-522-1510) ~ fax 1-888-236-4329 (406-522-0188) ~ doggon@doggon.com
No Reproduction Without Written Authority