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| This is a printable page Please scroll down for futher application instructions: Please send payment with the completed application to: Designer Breed Registry 20785 30th Avenue Barryton, Michigan 49305 If you have questions please call: 1-989-382-7004 9AM -5PM EST Monday thru Friday |
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Designer Breed Registry Application for Individual Registration of Purebred Dogs and Designer Dogs Breed:_______________________________________________________Date Of Birth:_________/______________/____________ Litter Number (if applicable)_____________________________________Breeder (If Known):_____________________________________________ Sex:( )Male ( )Female Color:______________________________________ Breed of Sire:___________________________________________Breed of Dam:_____________________________________________ Sire's Name:__________________________________________________Sire's Number if applicable:____________________________ Dam's Name:_________________________________________________Dam's Number if applicable:___________________________ Dogs Name:_|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Please print clearly in the above boxes. Names are subject to the approval of the Designer Breed Registry Registrant Information New Owners Name:____________________________________________Co Owner:_____________________________________________ Owners Address:_________________________________________________________________City:________________________________ Country/State:_________________________________Postal/Zip Code:_________________Phone:__________________________________ Signature Of Owner:________________________________________________Co Owner:_________________________________________ Email:_____________________________________________________________________________ Payment Method ( )Visa ( ) Master Card ( ) Check ( )Money Order Total$________________ Print name as it appears on credit card_____________________________________________________________________ Credit Card #_________________________________________________Expiration Date:________/_________/_________ By Signing Below the credit card holder authorizes the above charges to be charged to the credit card account number above Signature:___________________________________________________________Date:__________________ Please send payment with the completed application to: Designer Breed Registry 20785 30th Avenue Barryton, Michigan 49305 |
| (1) $15.00 Single Dog Option(2) 3-5 dogs $10./dog Option(3) over 5 dogs $5.00/dog Until 12/31/2008 |
| * Reduced fee until 12/31/2008 Beause of the overwhelming response to this promotion the DBR has extended the promotion unil 12/31/2008 |
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