Fields, marked with
*
, are required!
NOTE:
Materials cannot be shipped to a PO Box address.
*
Mailing Address:
*
Country:
-- Select --
Canada
USA
*
City:
*
Zip/Postal Code:
*
State/Province:
-- Select --
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces Americas
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Federated States Of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
*
Phone Number:
*
Shelter Name:
*
Do you currently microchip?
Yes
No
*
Are you a PetPoint/EPE User
?
Yes
No
*
Average Number of Adoptions/Month
Contact Person Information
*
First Name:
*
Last Name:
Email:
Material Required
To order the material(s) you need, please check the appropriate box(es) and specify the quantity.
NOTE: 24PetWatch Microchip materials (except the "Starter Kit") can be ordered only by the shelters who currently michrochip.
If you do not receive materials within 3 weeks, please call 1-866-375-7387 and ask to speak to your regional ShelterCare representative.
ShelterCare Insurance StartUp Kit (Display Stand, ShelterCare Tear Pad, Microchipping Tear pad)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Tear Pad (Purple) (50 per unit)
units
1
2
3
4
5
6
7
8
9
10
Microchipping Tear Pad (Red) (NOTE: For Shelters/Rescue groups promoting ShelterCare Insurance and registering microchip information with 24PetWatch) (100 per unit)
units
1
2
3
4
5
6
7
8
9
10
24PetWatch Microchip Registration Forms/Envelopes (NOTE: 24PetWatch Microchip materials (except the "Starter Kit" and "ShelterCare Tear Pad") can be ordered only by the shelters who currently microchip.)
units
1
2
3
4
5
6
7
8
9
10
TenantCare Tear Pad
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Poster
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Insurance Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
24PetWatch Microchip Identification Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Envelopes
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Tearpad Stand
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Intro Poster
units
1
2
3
4
5
6
7
8
9
10
24PetWatch Microchip Identification Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Intro Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Intro Tearpad Stand
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Poster
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Insurance Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
24PetWatch Microchip Identification Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Envelopes
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Tearpad Stand
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Poster
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Insurance Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
24PetWatch Microchip Identification Tearpad (50/Unit)
units
1
2
3
4
5
6
7
8
9
10
ShelterCare Tearpad Stand
units
1
2
3
4
5
6
7
8
9
10
Other Please specify here :
ShelterCare Pet Insurance Programs are underwritten in the U.S.A. by Praetorian Insurance Company, administered by PetCare Insurance Agency, (Brokers) Ltd. Underwriter varies by state and coverage is not available in AK. PetCare is a trademark of PETCO Animal Supplies, Inc. and is used with permission. ShelterCare Pet Insurance Programs are underwritten by Lombard General Insurance Company of Canada, distributed by PetCare Insurance Brokers Ltd. & GroupAssurance, inc. in Quebec. Coverage is available to all residents in all provinces, excluding the territories. PetCare Insurance Brokers Ltd. is a wholly owned subsidiary of
Pethealth Inc
.
© 2004 Pethealth Inc. All rights reserved. All images are the sole property of Pethealth Inc., and are not to be reproduced without permission.
