Duplicate Temporary Puppy Registration

Use this form to purchase a duplicate of a UCA Temporary Puppy Registration that has been lost or misplaced. * All duplicates can only be mailed to the breeder.

Requested Puppies' Information

Breed of Dog:

UCA Litter's Registration Number: *

List Bloodline: (optional)

Litter's Date of Birth: *

UCA Registered Name of Sire: *

Father of Puppy

Sire's UCA Registration Number: *

UCA Registered Name of Dam: *

Mother of Puppy

Dam's UCA Registration Number: *

Number of Female Applications Needed:

List Color / Markings of Females Needed:

Example: 1. Red Brindle/White 2. Black/White 3. White/Brown.

Number of Male Applications Needed:

List Color / Markings of Males Needed:

Example: 1. Red Brindle/White 2. Black/White 3. White/Brown.

Breeder / Litter Owner's Information:

Name of Breeder: *

First

Last

Breeder's Phone Number: *

Breeder's Email Address:

Confirm Email

Breeder's Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Applicant's Information:

This Application is Being Requested By: *

First

Last

Requester's Phone Number: *

Requester's Email Address:

Confirm Email

Requester's Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Comments:

Purchase Options:

Registration Choices: *

Duplicate Temporary Puppy Certificate (1)......$15
Duplicate Temporary Puppy Certificates (more than 1 puppy)......$25 total

*Only Request One Temporary Puppy Certificate Per Puppy

Additional Choices:

UCA Auto Window Decal....$8

Processing and Mailing Choices

Standard Processing......$0
RUSH Processing (5 business days)......$10
SUPER RUSH Processing (3 business days)......$15
Standard Mailing......$0
Outside of USA Mailing (Canada, Mexico, etc.)......$5
Overseas Mailing......$8

"Processing" refers to the in-house processing time. "Processing" does not apply to the delivery time required by the postal service.

Total

$ 0.00

Debit / Credit Card For Payment:

Select Type of Card

Name on the Debit / Credit Card *

First

Last

Debit / Credit Card # *

Expiration Date: *

Card Verification Code (CVC): *

3 digits on the back of the card

Signature: Please Sign

Name