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2. Customer Name
4. Dog Name
6. Color
8. Age
10. Rabies #
12. Vet Name
14. Payment Amount
16. Proof of Vaccination

    Please use the button above to upload your proof of rabies vaccination.

18. Payment

    After submitting the form, you will be taken to Graphite Payment, our secure payment merchant. You will be asked to enter in your Customer Name as well as your payment information so that your payment can be applied to the correct Customer.

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20. Submit

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