Loren's Pooper Scooper Service: We're #1 in the #2 Business!

Name
Address
Zip
Cross Streets
Home Phone		Work Phone
Cell Phone		E-Mail
Billing Address if Different from Physical Address
Name
Address
Zip
Name and Type of Pets
1)		2)
3)		4)
5)		6)
Type of Service
1) One Time		2) Once per week
3) Twice per week		4) Every other week
5) Quote		6) Other
Special Instructions (gate code, access location, etc.
Senior or disabled? (10% discount)
How did you find out about us?
Customer Referral (name and phone #)
I, the undersigned, hereby grant Loren's Pooper-Scooper Service and its designated representatives access to my property for the following services: pet waste removal, spraying of an odor eliminator, and/or a germicidal spray. This permission is given until such time as the service is terminated.
Name		Date