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Salutation: First Name: Last Name:
Address: City:
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Name of retailer where you purchased ZIMECTERIN® GOLD:
Location (Town):
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Date of purchase: / /
Number of ZIMECTERIN GOLD syringes purchased:
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Number of horses you own:
How often do you deworm your horses?
Yes, you may send me information about equine health and Merial® Brand Equine Products.