Pet Benefits

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About Pet Assure

Program Description

Enrollment Form


				Cash-Back Commissions
Step 1 - Please choose from the following plans:		Base Price	Each Additional Pet	Free Affiliate	Reseller Affiliate
	Individual Pet Planl (Annual)	$99.00 First Pet	$79.00	$4.00	$12.00
	Cat Pricing (for cats only) (Annual)	$59.00 First Cat	$49.00	$2.00	$6.00
	Family Plan $149 (Annual)	$149.00 First 4 Pets	$20.00	$8.00	$24.00
				Become a FREE Affiliate


Step 2 - Contact Information:
*Prefix:
*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*Home Phone:
Cell/Pager Phone:
E-Mail Addresses:	*Primary
E-Mail Addresses:	Alternate
*A valid primary email address is required so we can send you your enrollment information.
*Emergency Contact:
*Emergency Phone:
*User Name: Your primary email address will be your Pet Assure user name.
*Password:
*Confirm Password:


Step 3 - Pet Information:
*Number of Pets Under Plan:
Pet Name:
*Pet Type & Breed:
Pet Coloring:
Pet Age:	Years Months
Pet Gender:

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