Davidson County Rabies Tag Order Form

Davidson County Rabies Tag Order Form
Name of Animal Hospital*
Attn:

First NameLast Name
E-mail*
example@example.com
Contact Number*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is shipping address same as billing address?*

YesNo
Shipping Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Products*
prevnext( X )
One-Year Rabies Tag$800.00
Price is for each set of 100 tags. Tags come in boxes of 100. Payment is due when certificates are submitted to MACC. (Each tag costs the client $8.00)

Quantity

Three-Year Rabies Tag$2,400.00
Price is for each set of 100 tags. Tags come in boxes of 100. Payment is due when certificates are submitted to MACC. (Each tag costs the client $24.00)

Quantity

Certificate Books$ Free
Certificate books are en-triplicate and have 100 certificates. Animal hospitals that are sending certificates electronically or from their proprietary software do not need certificate books.

Quantity
How would like to receive the tags?*

MailPick Up at MACC
Pick Up:
Should be Empty: