The Special Pet Assure Order Form
for Cool Pooch Products, Inc.







Cool Pooch Sport Bottle - $5.99 (US)





Cool Pooch Bottle and Sport Sack - $11.99 (US)




First name:
Last name:
Address 1:
Address 2:
City:
State and Zip:

Promotion Code:


Credit Card

Card Number:

Security Number:

The Security Number is the 3 or 4 digit number on
the back of your credit card.
We need this to verify your purchase.

You will be notified of the amount total cost,
including the $5.95 per order shipping fee,
prior to your order being sent
or billed to your card.


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