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2. Dog License

   Proof of rabies vaccination must accompany application.

4. Applicant Information
6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. Address*
14. City*
15. State*
16. Zip Code*
18. Pet Information
20. Pet Name*
21. Color*
23. Breed*
24. Pet's Sex*

    1. Male
    2. Female
26. Neutered/Spayed*

    1. Yes
    2. No
27. Chip Information
29. Rabies Information
31. Tag Number*
32. Expiration Date*
34. Clinic*
35. Proof of Rabies Vaccination Record*
37. Fees
    License are only valid with valid rabies vaccination.
39. Animal License
    License Length
40. Price*
    -- Select One --Spayed/Neutered - $26Not Spayed/Neutered 1 year only available - $32

    License is only valid with valid rabies vaccination.

41. Quantity
42. Shipping Cost
44. Taxable
46. Data Practice Notice*

    1. I understand

    I understand that some of the information provided on this form will be public data. Public data is available to anyone who makes a request for such information.
47. Electronic Signature Agreement*

    1. I agree

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
49. Electronic Signature*
Leave This Blank:


51. Calculate Totals Proceed to Checkout

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