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How did you hear about Poopie Scoopers R-US?	Other:
*Email: REQUIRED**
Last time yard was cleaned up

*Name: REQUIRED**
Street:
City:
State:
Zip Code:

Subdivision Name

Directions from the Nearest Major Intersection:
Telephone - Home:
Telephone - Cell:
Telephone - Work:

Pets in or out when you're not at home?

Number of Dogs
Special notes about your pets
1. Name	Breed Age Social
2. Name	Breed Age Social
3. Name	Breed Age Social

Can the yard be serviced with pets out?

What Day(s) Is your Trash Pick Up?
Where Is Your Trash Receptacle Located?

Doggie door?
Type of Fencing:
Gates	How Many Gates: Locked Or Combination
Electric Fence	Boundaries

Billing Agreement Poopie Scoopers R-US clients invoices are mailed on the 5th of the month. You are given to the 15th of the month to avoid discontinued service. Clients may pay their invoice by cash, check by mail, or by credit card over the phone. If your payment is not made by the time we are billing out for the next month, your service will be suspended. A service charge of 1.5% per month, 18% APR, will be added to all overdue accounts. Also, liable for all legal and collection fees. A $25 late charge, per month for every month outstanding. There is a $50.00 return check charge on all checks that are returned. We do not get the check back, only a copy of the check. We cannot put it through again. Pay your bill each month, and everyone is happy!
You have read our billing agreement and agree with our terms

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Billing Agreement