Exit the Special Order

Special Order Request - Nature's Emporium

1. Customer Information

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* 1. Item is on Order?

Yes

No

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* 2. Department:

Dog Food

Cat Food

Dog Supplies

Dog APPAREL

Cat Supplies

Small Animal

Fish/Aquarium

WildBird

Gifts

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* 3. Customer Information:

Name (required): *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number (required): *

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* 4. OK to receive Text alert when item arrives?

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* 5. Item(s) Description:

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* 6. Insert UPC or ITEM #:

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* 7. Repeat Order (Y/N)?

Yes

No

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* 8. How frequent is the order?

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* 9. Enter Employee Name

Employee Name:

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* 10. Burlington 29 or Roanoke 32?

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* 11. Item is being transferred between store locations?

Yes

No

Have not checked with other store

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* 12. Other Comments: Which Stores are invloved with the transfer?