membership sign up

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Today’s Date:

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Activation Date:

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Store:

MEMBERSHIP SIGN UP PRIMARY MEMBER INFORMATION First Name:

Last Name:

Company Name: Address: City:

State:

Home Phone:

Cell Phone:

Email:

Birthday (mm/dd):

At which locations do you most frequent?

Branford

Zip:

¨ North Haven

¨ Bethel

¨ Manchester

¨ Middlefield

¨ North

¨ Southington (Check all that apply. Circle favorite if more than 1 is checked.)

¨ Yes! please send weekly sales newsletters, store events, and announcements to my email address. Preferred contact method: ¨ Snail Mail ¨ Email ¨ Text Message Signature:

Today’s Date:

TELL US ABOUT YOUR PETS (up to 5 pets may be added)

Receive an annual gift within the pet’s birthday month + bonus Club points with your first pet profile! Pet 1 Name:

Pet 2 Name:

Pet 3 Name:

Pet 4 Name:

Pet 5 Name:

Pet 1 Type:

Pet 2 Type:

Pet 3 Type:

Pet 4 Type:

Pet 5 Type:

Breed:

Breed:

Breed:

Breed:

Breed:

Birthday (mm/dd/yyyy):

Birthday (mm/dd/yyyy):

Birthday (mm/dd/yyyy):

Birthday (mm/dd/yyyy):

Birthday (mm/dd/yyyy):

Pet 1 Favorite Food:

Pet 2 Favorite Food:

Pet 3 Favorite Food:

Pet 4 Favorite Food:

Pet 5 Favorite Food:

Pet 1 Favorite Treats:

Pet 2 Favorite Treats:

Pet 3 Favorite Treats:

Pet 4 Favorite Treats:

Pet 5 Favorite Treats:

¨ Cat ¨ Dog ¨ Other:

¨ Cat ¨ Dog ¨ Other:

¨ Cat ¨ Dog ¨ Other:

¨ Cat ¨ Dog ¨ Other:

¨ Cat ¨ Dog ¨ Other: