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

Your Name (Puppy Owner): *

First NameLast Name
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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 Pedigree
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 approved registration(s) older than 1 year will incur additional late fees and penalties.

$100.00

Certificate Of Registration with a 6 Generation Pedigree
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 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*

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

Monroe, NC 28112

(864)936-1158
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