On-Line Form for FAXING or MAILING purposes.

FILL IN ON-LINE, PRINT and either FAX or MAIL it.

All information will be held in the strictest of confidence by Home Checkers.

 

Your Particulars:

Name:  
Address:  
City  
Province :    
Postal Code:   
Tel. No.    Area Code: Number:   
Tel. No.    Area Code : Number :   
Email : :   

 

Appointment Time

Appointment Time ( Preference ) : AM PM Check the boxes on the PRINT copy

Preferred Time: (ie. 9:00 to 12:00 )

Day of Week ( Preferences - Choose one or more) :

Monday Tuesday Wednesday Thursday Friday

Saturday Sunday Check the boxes on the PRINT copy

Specific Date(s) - List one or more

 

Pet Care Services Information :

 

Do you have any pets ? Yes ___ No ___

If yes, how many and what type of pets ?

 

Comments:

 

PRINT AND FAX TO US AT: (613) 723-6250 OR,

MAILTO:

HOMECHECKERS, 1568 Merivale Road, Suite 321, Ottawa, Ontario, K2G 5Y7.