Please print this page out. Mail it to us. Puppy Breeders Club P O Box 225 Aurora Mo 65605
	Name:
	Address:
	City:
	State:
	Zip:
	E-Mail:
	Phone:
	INFORMATION FOR YOUR AD
	Business Name:
	E-Mail For Ad:
	Phone Number For Ad:
	Club Affiliations & Registries:
	Ad:
	Payment Information: Credit Card Number: __________________________ Expiration Date:__________________ Name: Personal Check: Please make check payable to Cindy Miller - Only for previous customers. First time customers please send a money order or cashiers check. Money Order/Cashiers Check: Please make money order payable to Puppy Breeders Club