Microchip Registration Form

Surgery Date You Signed up For*

Date

Your First Name*

Your Last Name*

Your Address

Street Number and Street Name*

Apt.*

City*

State*

Zip Code*

E-mail Address*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Ext.

2nd Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Ext

Alternate Contact

First Name

Last Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Ext.

2nd Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Ext

Pet Name*

DogCat

You're Almost Done.

You will find the "submit" button at the end of the following information. If you do not see a Thank You Notice after clicking "Submit," we have not received your form.

Ace of Spays Microchip Fee includes a Lifetime Registration

Your pet's microchip ID number will be permanently registered in the HomeAgain National Pet Recovery Database, along with your contact information.

Always keep your contact information up to date by calling Home Again when you move or change phone numbers. Youcan reach Home Again by phone at 1-888-HOMEAGAIN (1-888-466-3242)

HomeAgain's Terms and Conditions/Privacy Policy Notice

Intervet Inc. doing business as HomeAgain' ("HomeAgain") offers a pet recovery service for pet safety...[Verbage regarding the set up fee and the annual membership fee has been removed as the former is paid for in the purchase of your chip and the latter is a separate program from the registry for which you will be registered for the life of your pet.]

By enrolling your pet in the HomeAgain program you authorize your veterinarian or shelter to share information about you and your pet with HomeAgain. This authorization may be terminated by calling HomeAgain at 888-HOMEAGAIN (388-466-3242) This termination will be effective within 3 business days after your call is received.

HomeAgain is committed to protecting your privacy. To understand our data collection and use practices, please visit our Website. The HomeAgain Privacy Policy can be accessed at www.homeagain.com by following the link titled "Privacy Policy."

Following your enrollment you will receive additional correspondence that contain links to the HomeAgain Terms and Conditions and the HomeAgain Privacy Policy.

Your Agreement with HomeAgain is subject to the laws of the State of New Jersey. If there is any dispute concerning the HomeAgain Terms and Conditions, theHomeAgain Privacy Policy or your use of the HomeAgain Program. you and HomeAgain agree to submit the dispute to nonbinding mediation, followed by binding arbitration under the rules of the American Arbitration Association.

If you have questions or concerns about the HomeAgain Program or the HomeAgain Terms and Conditions, please contact them at HomeAgain Customer Service, 2 Giralda Farms, Madison, New Jersey 07940 email them at customerservice@homeagain.com: or call them at 1-888-HomeAgain (1-888-466-3242)

CONTACT [THEM]

If you have questions or concerns about the HomeAgain Privacy Policy, please contact them at the HomeAgain Privacy Office, 351 No. Sumneytown Pike, UG4B-24, North Wales, Pennsylvania 19454 USA; or email them at merck_privacy_office@merck.com.

HomeAgain Pet Recovery

HUMAN CONTACT INFORMATION

PET INFORMATION

You're Almost Done.

Ace of Spays Microchip Fee includes a Lifetime Registration

HomeAgain's Terms and Conditions/Privacy Policy Notice