Dog Collar Repair Service Request Form

Ship to: (if different than Billing Address)

Name: ________________________________________________

Address: ______________________________________________

City, State & Zip_________________________________________

Daytime Telephone #______________________________________

Repair Service Request Form
Please print this form, complete the information and enclose it with your trainer.
800-430-2010 or 231-947-2010
Ship to:
Collar Clinic
1517 Northern Star Drive,
Traverse City MI 49696

Bill to:

Name: _____________________________________

Address: ___________________________________

City, State & Zip_____________________________

Daytime Telephone #__________________________

Email Address:(optional)________________________

My Training Collar Information

Model:______________________________Serial Number________________

Comments / Problems with my Trainer

____________________________________________________________________________________________

I would like to purchase the following accessories:

____________________________________________________________________________________________

____________________________________________________________________________________________

My Payment information:

Credit Card #: ________________________________________________ Expiration Date________
CVV# (3 digit code from the signature box)_________

Signature__________________________________________

Personal Checks or Money Orders should be made payable to Collar Clinic

Check or Money Order Enclosed ________________________________ Amount: $_______________
Request COD return? Yes_________ Note: $10.00 COD fee is added to the flat rate repair fee.
A money order or bank certified check made payable to Collar Clinic is required at delivery.