Dog Collar Repair Service Request Form

Ship to: (if different than Billing Address)

Name: ________________________________________________

Address: ______________________________________________

City, State & Zip_________________________________________

Daytime Telephone #______________________________________

Trade-In Evaluation or Repair Service Request Form
Please print this form, complete the information and enclose it with your trainer.
Please include all the accessories for highest trade value. We also like to see charger(s) for any repair.
800-430-2010 or 231-947-2010 FAX to 231-947-6566
Ship to:
Collar Clinic
1517 Northern Star Drive,
Traverse City MI 49696

Sender:

Name: _____________________________________

Address: ___________________________________

City, State & Zip_____________________________

Daytime Telephone #__________________________

Email Address:(optional)________________________

My Training Collar Information

Model:______________________________Serial Number________________

Comments / Problems with my Trainer/ New Model Interested in?

____________________________________________________________________________________________

I would like to purchase the following accessories:

____________________________________________________________________________________________

____________________________________________________________________________________________

My Payment information:
Or Please call me for my credit card 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.