KittyCheck™ Order Form:( Please print )                                  Coupon Code: ___________

How did you hear about KittyCheck™: ________________________   

Name:__________________________________________________

Shipping Address:      Street Address:__________________________________________

City:_______________________________________ State:______ Zip Code:____________

If we need to contact you about your order:

Email address:_______________________ Daytime phone number:____________________

Payment method:      Check    Money order

Make your check or money order payable to: Systems Complete

Billing Address (if different):   Street Address:______________________________________

City:__________________________________ State:______ Zip Code:________________

Signature:__________________________

Number of KittyCheck 1 ordered: _____ @ $5.95    Total: $ ________                 

Number of KittyCheck 2 ordered: ______ @ $5.95    Total: $ ________

Number of KittyCheck 3 ordered: _____ @ $5.95    Total: $ ________

Number of KittyCheck 4 ordered: _____ @ $5.95    Total: $ ________

Number of Maintenance Kits ordered: ______ @  $19.95   Total: $ __________

CA Tax (if applicable): $________  Coupon (if applicable): $_________   Purchase Total: $___________

Note: Residents of California ONLY, please add 8.25% sales tax.   Do not forget to subtract your discount coupon, if you have one. 

Send this form to:

Systems Complete, LLC

265 Sobrante Way Suite M