CLIENT INFORMATION
Name:
Address:
City:
State:
International
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
Zip:
Phone:
E-mail:
Dog's Name:
Breed:
Weight:
Age:
Male/Female:
Male
Female
If male, Neutered/Intact:
Neutered
Intact
MEASUREMENTS
NOTE: All measurements must be taken with the dog held in an upright healthy standing position.
NOTE: All measurements should be taken with a rigid tape measure or yardstick. Measurements C and E are welded in place and are not adjustable. To get an accurate measurement for E, the width of the dog at the widest point, place a hardcover book or clipboard on either side of the pet at the shoulders, ribcage, and rump. Measure the space between them at the widest point with the fur compressed. We are not responsible for carts made to inaccurate measurements. Please double check your measurements.
A - Height from floor to top of shoulder
B - Length from center of shoulder to front of thigh
C - Length of thigh
D - Height from floor to groin
E - Shoulders
E - Ribs
E - Rump
What is the strength of your pet's front legs?
strong
normal
weak/impaired
How did you find Eddie's Wheels?
search engine
vet referral
print media
handicappedpets.com
tv/radio
Other
Please describe your pet's exercise terrain:
Please describe in detail the nature of your pet's disability:
Please be sure to give us a daytime phone number where we can reach you to confirm your measurements, discuss your pet's particular needs and get your billing and shipping information. We accept all major credit cards. We make every effort to ensure that we will ship all standard carts no more than 2 calendar weeks after receiving completed information. Front wheel carts, powdercoated carts and custom orders may take longer. Please refer to the pricing page for information about our policy and warrantee. We ship all carts, unless specified, as fully assembled carts via Fedex Ground. By submitting this order form, I confirm that I have clicked on this link and have read, understood and agree to the terms and conditions detailed in the Eddie's Wheels Policies and Warranty section.