Name

Address


Telephone number with area code


E-mail

  I have internet access and have already completed the database online - Internet Kit

  I do not have internet access and will need a copy of the Database Questionnaire form mailed to me with my kit - Non-Internet Access Kit

Total Number of kits requested and type of kit requested

THE PRICE FOR BANKING IS:

:$15.00 per kit

When payment is received, the brushes will be mailed to you. After you have completed the database (either online or by mailing in the form) and returned the DNA swabs, the release form and a 3-generation pedigree (if known) to the bank, you will be reimbursed by SCARF.

To Pay online click here

Otherwise Print out this form and send with payment to:

DOGenes Inc.,

161 Sherin Ave.,

Peterborough ON, K9J 7V5

CANADA