AMERICAN STOCK DOG REGISTRY, LLC APPLICATION FOR LITTER REGISTRATION     GENERAL INFORMATION  Breed: Litter Date of Birth (mm-dd-yyyy) : - - Number of Males: Number of Females:   DAM (Female) INFORMATION  Registration Number: - - Registration Name: Registration Issue Date (mm-dd-yyyy) : - - Owner First Name: Owner Last Name: Owner Address: Owner Address(2): City: State: ZIP Code: Telephone Number: ( ) - Email Address: SIRE (Male) INFORMATION  Registration Number: - - Registration Name: Registration Issue Date (mm-dd-yyyy) : - - Owner First Name: Owner Last Name: Telephone Number: ( ) - Email Address: PAYMENT  Credit Card:    Visa    MasterCard    Discover    Account Number:    Expiration Date (mm-yy) : - Litter Processing Fee: $20    Cardholder Signature: AGREEMENT  Owner Signature: Sire Signature:    Please submit this form by mail to:    American Stock Dog Registry, LLC, P. O. Box 7510, Columbia, Missouri 65205    or by fax to: (480) 247-5516.