| Designer Breed Registry Litter Application Breed: ___________________________________________________Born:________/_________/____________ Males[ ] Females[ ] Name of Sire:_________________________________________________ Breed__________________________________________Reg.#________________________(If known) Name of Dam:___________________________________________________ Breed:__________________________________________Reg.#_______________________(_if known) Owner of Litter Name:________________________________________________DBR Breeder # (if known)___________________ Address:______________________________________________City:_____________________________________ Country/State:_________________________________________Postal/Zip Code:____________________________ Phone_______________________________ Email:___________________________________________________ Signature of Owner of Dam__________________________________________Date:__________________________ Method Of Payment ( ) Visa ( ) Master Card ( )Discover ( ) Amex ( ) PayPal ( )Check ( ) Money Order Total $25.00 Print name as it appears on credit card: _______________________________________________________________________________ _______________ Credit Card # Exp.Date cvc code ________________________________________________ ______/______/_____ _____________ By signing below cardholder authorizes this charge _________________________________________________________Date___________/____________/______________ Please make checks or Money Orders Payable to: Designer Breed Registry Mail to: Designer Breed Registry PO Box 238 Barryton, Michigan 49305 Phone: 1-732-256-9415 |
| Printable Page |
ONLINE REGISTRATION
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The DBR is not responsible for owner errors when
filling out this online registration a correction fee of
$15.00 will apply if the registration has issued and
must be re issued.
filling out this online registration a correction fee of
$15.00 will apply if the registration has issued and
must be re issued.
