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Emergency ConTAK™ Cards:

• Basic Version
• Car Seat Version
• Medical Version
• Pet Version
• Purchase
• Out-of-Area Version

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To order, please complete the following online order form with the information that will appear on the Emergency ConTAK™ Card.

All fields marked with * are required:

INFORMATION FOR EMERGENCY CARD
Enter pet owner's information.
Full Name:*
Address Line 1:
Address Line 2:	(Optional)
City:
Prov./State:
Postal/Zip Code:
Home Phone #:	(eg. 604-123-1234)
Alternate Phone #:	(eg. 604-123-1234)
Number of Pets:*	(Max. 4 pets)
Enter up to 3 emergency caregiver contacts.
Contact Full Name:*
Phone #:*	(eg. 512-123-1234)
Alternate Phone #:	(eg. 512-123-1234)
Contact Full Name:
Phone #:	(eg. 512-123-1234)
Alternate Phone #:	(eg. 512-123-1234)
Contact Full Name:
Phone #:	(eg. 512-123-1234)
Alternate Phone #:	(eg. 512-123-1234)
Enter up to 4 pets.
1. Pet Name:*
Type of Pet:*
2. Pet Name:
Type of Pet:
3. Pet Name:
Type of Pet:
4. Pet Name:
Type of Pet:
Enter veterinarian contact.
Veterinarian Name:
Clinic Phone #:	(eg. 512-123-1234)
After-hours Line:	(eg. 512-123-1234)

Buyer's Full Name:*
Confirmation Email:*	Confirmation of your order will be sent to this email address
Customers are responsible for the accuracy of all information submitted. Please double check for errors and review the Terms & Conditions before submitting. If you accept the Terms & Conditions on this website, click the Submit Form button below.

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Prefer to order OFFLINE? That's fine!

Simply download the order form, fill it in, and mail it to us. It couldn't be easier! To download, right-click the link and select "Save Target As..." or "Save Link As...". For Canadian Residents - Right-click here to download For U.S. Residents - Right-click here to download Requires Adobe Reader (Free)