Name:
Address:
Primary Phone Number:
Phone Type: Home Work Cell *
Secondary Phone Number:
E-mail Address:
Desired Frequency Of Cleanings Twice per week Once per week Every other week One-time cleaning *
How long since yard was cleaned? Within the last week Within the last two weeks Within the last month One to two months ago More than two months
Number of dogs: 1 2 3 4 5 6+
Dog#1: (Name)
Breed:
Color/markings:
Temperment/disposition: Very friendly A barker but will not bite Somewhat aggressive Very aggressive Unknown
Dog#2: (Name)
Dog#3: (Name)
Dog#4: (Name)
Dog#5: (Name)
Dog#6: (Name)
Is your yard: Small to Medium Typical 1/4 acre lot Larger than 1/4 acre lot
When looking at your house, where is your gate located? Left Front Right Front Left Side Right Side Rear
Is gate locked? Yes No
Is the lock a: Combination lock Key lock
Thank you for choosing Poopie Patrol! We value and appreciate your business and look forward to serving you for many years to come. A representative will call you shortly to complete the sign-up process and inform you of your service day(s).
