Dog License Application Form
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Is this a NEW License, RENEWAL License or Change in Status?
*
New
Renewal
Change in Status (Pet Deceased, Rehomed, etc)
Pet's Name:
*
Breed:
*
Specify reason for status change:
*
Pet is deceased.
Pet has been rehomed out of my care.
Is your Dog Spayed or Neutered
Spayed/Neutered
NOT Spayed/Neutered
Current License Number:
Is this a Late/Past Due License Renewal?
*
Yes - Add $40 late fee
No
License Expiration Date
-
Month
-
Day
Year
Date
Please upload a current signed Rabies Certificate:
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Date of Rabies Vaccination:
*
-
Month
-
Day
Year
Date
Date Rabies Vaccination Expires:
*
-
Month
-
Day
Year
Date
1 Year Eligibility for Sterilized Dog:
1 Year Spayed/Neutered License Fee $15
1 or 2 Year Eligibility for Sterilized Dog:
1 Year Spayed/Neutered License Fee $15
2 Year Spayed/Neutered License Fee $30
1, 2, or 3 Year Eligibility for Sterilized Dog:
1 Year Spayed/Neutered License Fee $15
2 Year Spayed/Neutered License Fee $30
3 Year Spayed/Neutered License Fee $40
1 Year Eligibility for Unaltered Dog:
1 Year Unaltered License Fee $25
1 or 2 Year Eligibility for Unaltered Dog:
1 Year Unaltered License Fee $25
2 Year Unaltered License Fee $50
1, 2, or 3 Year Eligibility for Unaltered Dog:
1 Year Unaltered License Fee $25
2 Year Unaltered License Fee $50
3 Year Unaltered License Fee $60
License Fee
*
Late Fee?
Processing Fee
*
Total
Rabies Difference
Total
*
Notes
Payment
*
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USD
License Fee
Credit Card
Submit
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