FieldsetPlease Specify Schedule Request Thank you for inquiring about Cozy Care Pet Services! By completing this form, there is NO OBLIGATION. This form helps us gather information about you and your pet(s), so we can customize services to best fit your needs. At Cozy Care Pet Services, we ensure that your pet is pampered and receives the individualized care they deserve! If this is your first time inquiring about services, please complete the new client application instead. We will then call you to answer any and all questions that you have prior to a meet and greet appointment. Our scheduling department will e-mail you a welcome note as well. Please feel free to call us at 734-386-0242 with any questions you may have. We look forward to speaking with you soon!Name FirstName LastAddress Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryMobile Phone Number Home Phone Number Work Phone Number Email Re-enter Email Preferred way to be contacted to confirm this appointment * Choose onePhoneE-MailAbout your pet(s) Pet #1 - Name, Breed and Age *Special Needs or Health Concerns Pet #2 - Name, Breed and Age Special Needs or Health Concerns Pet #3 - Name, Breed and Age Special Needs or Health Concerns Do you have any additional pets? If so, please list here Any additional information you'd like to add (such as favorite activities, qualities you look for in a pet sitter, etc.)? Date About your appointment What service would you like to schedule? Regular Dog WalkingCat SittingPuppy CareVacation Pet SittingOvernight Pet SittingPet TransportationDog Park VisitDoggie DaycarePackage * Choose a packageStandard (30-Minute)Deluxe (45-Minute)Ultimate (60-minute)Start Date End Date Pick a date. Preferred time of service (Please indicate a two-hour arrival time window) for dogs and for cats please indicate morning, afternoon or evening. If you pet has special needs and you need a smaller window for arrival please let us know. * Frequency of service * Please use this box to provide us with additional details about when you need visits, if necessary. How would you like to be updated during the pet sit? By PhoneBy TextBy MailBy Doggie Latchkey's "Report Card"How did you hear about Cozy Care FacebookGoogleOther Search EngineOnline DirectoryReferralOthersAdditional Notes Note: “By signing this electronically, I certify that my electronic signature is sufficient as my written signature and that the above information is true and accurate to the best of my knowledge.” VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
