Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Please identify and describe your pet:

Name
Age	Years Months
Sex	Male Female
Weight	Ibs.
Species	Dog Cat Bird Reptile Ferret Hamster Guinea Pig Fish Rodent Wildlife Other : Specify Below
Other
Color

Choose one of the following options:

Cremains returned to veterinarian.
Cremains shipped to your home.
Cremains picked up at Good Shepherd.

Please provide the following contact information for your veterinarian:

Name
Title
Clinic / Hospital
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Website

Choose the urn you want to have the cremains returned in:

Please select a Urn Pewter 402 Pewter 401 Pewter 301 Pewter 101 Black and Gold 3" Brass Urn Silver and Gold 3" Brass Urn Black and Gold 6" Brass Urn Silver and Gold 6" Brass Urn Black and Gold 7" Brass Urn Silver and Gold 7" Brass Urn Black and Gold 10" Brass Urn Silver and Gold 10" Brass Urn Bronze Olympus Bronze Athenian Bronze Spartan Bronze Roman Oak Picture Window Maple Picture Window Cherry Picture Window Mahogany Picture Window Walnut Picture Window Carved Top Tapestry Urn Brass Feline Sienna Sitting Brass Feline Sienna Pouncing Brass Feline Cupric Slate Brass Feline Lucent Sage Porcelain Ebony Sitting Feline Porcelain Ebony Turned Head Feline Porcelain Ivory Sitting Feline Porcelain Ivory Turned Head Feline 3" Marble Teak Urn 7" Marble Teak Urn 11" Marble Teak Urn Kitty Kin Keepsake Box Fascinated Feline Keepsake Box Life Size Urn Laser Top Urn Figurine Urn Small Leaf Alloy Urn Large Leaf Alloy Urn