Request Service

Date

Clinic

Pet Owner

Address

City

State

Zip Code

Phone

E-mail

Pet Name

Breed

Weight

I hereby certifiy that I am the owner of the above described pet. I hereby give Wheeler Petuary my permission to cremate my pet and shall not hold Wheeler Petuary, its employees, or its agents liable. If cremains are not claimed within 90 days, I authorize the cremains to be disposed of by any manner permitted by law.

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