Online Temporary Puppy Registration / Permanent Registration

Please enable JavaScript in your browser to complete this form.

This online form is intended to allow users to submit a Temporary Puppy Registration electronically rather than mailing your hard copy. By submitting this form, you acknowledge that your physical (hard copy) temporary registration is voided and replaced by this digital submission.

You **MUST** completely fill out your in-hand hard copy Temporary Puppy Registration paperwork. Write ***VOID*** on the LOWER PORTION OF THE FRONT SIDE of your Temporary Puppy Registration prior to attaching it to this online application.

DO NOT apply Credit Card/Debit Card information on the hard copy/paper copy but rather insert it on this online application.

**This form is NOT intended as a replacement for a LOST Temporary Puppy Registration. If you have lost your Temporary Registration Application your breeder must complete a Duplicate Temporary Puppy Registration form found on the Online Registration Page of our website**

Please read and follow the instructions in the above paragraph:

No, I did not read the above paragraph
Yes, I did read and understand the above paragraph

Please acknowledge that you have read the above paragraph as it is a very important step. If not done properly it will delay the process of your paperwork.

Name of Dog to be Registered:

Please limit to 25 characters.

Upload Front of the Temporary Puppy Registration Application:

Click or drag a file to this area to upload.

Utilizing a permanent marker write ***VOID*** on the LOWER PORTION OF THE FRONT SIDE of your Temporary Puppy Registration prior to attaching it to this online application.

Upload ***COMPLETED** Back of the Temporary Puppy Registration Application:

Click or drag a file to this area to upload.

You **MUST** completely fill out your in-hand hard copy / paper Temporary Puppy Registration paperwork. DO NOT apply Credit Card/Debit Card information on the hard copy/paper copy but rather insert it on this online application. If credit/debit card information has already been applied, white it out. **DO NOT WHITE OUT ANY OTHER SECTION OF THE APPLICATION**

Please read and follow the instructions in the above paragraph:

Yes, I did read and understand the above paragraph

Please acknowledge that you have read the above paragraph as it is a very important step. If not done properly it will delay the process of your paperwork.

Owner's Information:

Name of Owner:

First

Last

Name of Co-Owner: (optional)

First

Last

Co-Owner - Type of ownership: (optional)

Please select one of the following: "and" requires both owner's signatures, "or" requires either signature.

Owner's Phone Number:

Co-Owner's Phone Number:

Owner's Email:

Confirm Email

Owner's Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Photos:

3 photos (2 profile shots & 1 frontal head shot) **MUST** accompany this application.

#1 Photo - Front:

Click or drag a file to this area to upload.

#2 Photo - Left:

Click or drag a file to this area to upload.

#3 Photo - Right:

Click or drag a file to this area to upload.

#4 Photo - Optional:

Click or drag a file to this area to upload.

Comments:

Registration/Pedigree Options:

Yes, I have selected all my desired registration options on the back side of my Temporary Puppy Registration Application prior to attaching it to this Online Form.

Late Fee: (If applicable)

Yes, I understand and agree. If a late fee applies ($20) and it is not selected it will automatically be added to the total amount due.

Total Amount Due:

Debit / Credit Card For Payment:

Select Type of Card

Name on the Debit / Credit Card:

First

Last

Credit Card Number:

Expiration Date:

Card Verification Code (CVC):

3 digits on the back of the card

Billing Address:

Address Line 1

Address Line 2

City

State

Zip Code

I do hereby certify that I am the true owner of the dog described above and that all of the information provided by me on this application is correct to the best of my knowledge and belief:

Clear Signature

Please Sign Above.