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CLIENT CONCERN APPLICATION
If a customer has any concerns or questions please fill out and fax. Please fill out the following and fax it to (954)885-6655 or email it to gildaftlaud@aol.com PLEASE CALL 954-885-6600 TO CONFIRM THAT WE HAVE RECEIVED THIS FAX.
Date: _______________ First Name: ________________________ Last Name:____________________ Address: ___________________________________________________________________ City: ____________________, State: ______________________, Zip Code: _____________
Telephone: _________________________, Email Address:
_____________________________
Breed: ________________________________ Male/Female Purchase Date: ___________________________ Amount Paid: $___________________________ Was the puppy taken to the Veterinarian within 72 hours of the purchase date? YES/NO Comments: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ |