Barry March 11, 2014 Leave a Comment Service Request Online Service Request TODAYS DATE Date Format: MM slash DD slash YYYY Name First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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)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 ARRANGEMENTSHow many dogs are in the home?* 1 dog 2 dogs 3 dogs 4 dogs 5 dogs or more (please call for rates) Dogs Name(s)Dog(s) access to yard?*I have a dog door and it is always openI have a dog door but it is only open if I am homeDog is out when no one is homeDog(s) only out if I am homeTemperament*Friendly (good with strangers entering the yard)AggressiveUnsurePayment InformationHow would you like to be billed for service?*Please enroll me in automatic billingMail my invoiceEmail my invoice*ONE TIME CUSTOMERS MUST PROVIDE A CREDIT CARD TO SCHEDULE SERVICE Credit Card or Debit CardVisaMastercardAmerican ExpressBy providing your credit card information we will automatically bill your credit card monthly for your service rate and your total charges will appear on your monthly credit card statement as SCOOPYDOO 248-969-9400 NO INVOICE WILL BE SENT. Card NumberExpiration DateName on CardAuthorization* By submitting this form, you are authorizing Scoopy Doo to perform the requested service(s) and payment options selected. TODAYS DATE Date Format: MM slash DD slash YYYY
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