U.P.P.C.C. Invoice Puppy Registration (Website)

Your Name (Puppy Owner): *

First NameLast Name
Phone Number:*
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Billing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is shipping address same as billing address?*

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Shipping Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Breeder's Name:*

First NameLast Name
Your Breeder's Phone Number:*
Please enter a valid phone number.
Your Dog's Name:

Your Choice of NameBreeders Kennel Name: (N/A if unknown)
Your Dog's Parents:

Sire (Male)Dam (Female)
PLEASE ONLY MAKE ONE CHOICE BELOW
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Certificate Of Registration with a 3 Generation PedigreeAll dates are verified with your breeder using the puppy registration they submitted. Registrations are considered null and void after 1 year from the date you purchased your puppy. Any approved registration(s) older than 1 year will incur additional late fees and penalties.
$100.00

Certificate Of Registration with a 6 Generation PedigreeAll dates are verified with your breeder using the puppy registration they submitted. Registrations are considered null and void after 1 year from the date you purchased your puppy. Any approved registration(s) older than 1 year will incur additional late fees and penalties.
$135.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00
Signature*

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This payment is NON-Refundable. ALL SALES ARE FINAL!
U.P.P.C.C

Monroe, NC 28112

1-866-777-3727
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