Bravecto Order Form

MSD Animal Health (Bravecto) and WIRES have partnered to distribute Bravecto Spot-on for Dogs to mange treaters around the country.

WIRES distributes these doses from Sydney, posting them to authorised rescuers and groups. Please note, that only one person per organisation should complete this form.

First Name *

Last Name *

Organisation name *

Position *

Contact phone number *

Email address *

Delivery address for Bravecto supplies*

Street Address *

Suburb *

City *

State *

Postcode *

How many doses of Bravecto Spot-on for Large Dogs (1000MG) would you like to request?

Please select Yes below to confirm you agree with the following *

Yes

No

Have you already provided WIRES with your Mange treatment permit? *

Yes

No

Wildlife Permit

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