One Time Service Online Service Request Date Name First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Contact PreferencePhoneEmailHow did you learn about us?*Service InformationHow long has it been since the yard has been cleaned?*Less than 3 weeks (no additional charges apply)More than three weeks (additional one time fee applies, see below)FOR PRICING SEE RATES How often is service needed?*WeeklyTwice a week (not offered in all cities)Every other weekMonthlyOne time only (credit card payment is required to schedule service)How many dogs are in the home?* 1 dog 2 dogs 3 dogs 4 dogs 5 dogs or more (please call for rates) Do you have an over-sized yard?* Yes No Please note: Prices are based on a total cleaning area of approximately 4,500 square feet (60x70) area. Fees apply for additional cleaning area and the difficulty of the service area to be cleaned. You will be notified of any price adjustments needed before they apply.Area to be cleaned* Back Front Run Pen Lead Area Full Yard Other If "other" to above, where is the location?How will our service tech access your yard?*Yard is fully accessibleGate is locked ( access/key/combo need below)OtherLocation of key ,combination of lock , or instructions to access yardCustomer notification of service (no charge for disabled or handicapped)*No notification neededKnock when we arrive ($1.00)Call before we arrive ($1.00)Text before we arrive ($1.00)About Your DogsTO ENSURE THE SAFETY OF YOUR DOG AND OUR STAFF, WE PLEASE ASK OUR CUSTOMERS TO KEEP DOGS IN HOME AT TIME OF SERVICE. PLEASE CONTACT OUR OFFICE IF YOU REQUIRE SPECIAL ARRANGEMENTSDogs Name(s)Temperament*Will be in and has no access to yardAggressiveFriendly (good with strangers entering the yardPayment InformationHow would you like to be billed for service?*Please enroll me in automatic billingMail my invoiceEmail my invoiceONE TIME CUSTOMERS MUST PROVIDE A CREDIT CARD TO SCHEDULE SERVICE Credit Card or Debit CardVisaMastercardAmerican ExpressCard NumberExpiration DateName on CardAuthorization* By submitting this form, you are authorizing Scoopy Doo to perform the requested service(s) and payment options selected. Date