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)
Sire Owner First Name:
Sire Owner Last Name:
Telephone Number:
(
)
-
Email Address:
PAYMENT
(Litter Processing Fee: $20)
Credit Card:
Visa
MasterCard
Discover
Account Number:
Expiration Date:
-
(mm-yyyy)
Cardholder Signature:
Date:
AGREEMENT
Owner Signature:
Date:
Sire Owner Signature:
Date:
Please email Litter Registration papers to Dam Owner's Email Address.
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
.
