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

Your Name (Puppy Owner): *

First NameLast Name
Phone Number:*
Please enter a valid phone number.
Billing Address:*

Street Address

Street Address Line 2

CityState / Province

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

YesNo
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)
*
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Permanent Registration Fee-- All 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 late registrations will only be honored on a case by case scenario and must have the approval of the U.P.P.C.C. Board Members. Any approved registration(s) older than 1 year will incur additional late fees and penalties.
$100.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00
Signature*

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

P.O. Box 1418

Pataskala, OH 43062

1-866-777-3727
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