USA Register My Pet

USA Registration Form

Please fill in the form below.
Full Name *

Prefix First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Email
example@example.com

Emergency Contact/Secondary Owner

All fields must be answered
Is this an Emergency Contact or Secondary Owner

Secondary Owner Emergency Contact
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Breeder/Rescue

Please add breeder or rescue information if available
Name Of Breeder or Rescue
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email
example@example.com

Pet Information

Please give as much information as possible
Name Of Pet 1 *
Type Of Pet *
Sex Of Pet *
Breed Of Pet *
Microchip#
Implantation Date Of Microchip
If known
Pet Passport #
If applicable
Tattoo ( if any)
PID # If registering an Equine
Premises ID # of where Equine is located
Rabies Tag #
Please enter your pets Rabies Tag #
Age of pet *
Example 0.5 for 5 months and 5.0 for 5 years
Color Of Pet *
Please give color of pet with any markings
Rescue or Breeder Information
Please put Name, Address and Phone # and email address.
Pets Picture

Browse Files
Please make sure you have a clear picture of your pet. This can be added to an ID Card or our database. Cancel of
By signing this form you agree to International Pet Registry to :

Charging your credit card for the fee requested by you and that you have read and agreed to the terms and conditions provided below.

You also agree to

1. International Pet Registry acting on your behalf by contacting local authorities and organizations regarding your pet in the event of your pet becoming lost, found,involved in a disaster or releasing medical information of your pet and owner information. This could be to Livestock Investigator Services, Local Police Departments, Veterinary Clinics, Bylaw Enforcement, Animal Control and Shelters

2. You also agree that you are the legal owner of said animal and that the registrant understands that International Pet Registry holds no responsibilty for false claims and information given about ownership and pet.

My Products *

Microchip Registration $ 19.95

Basic Microchip Registration For Your Pet. You will be charged $10.50 per year after initial transaction.

Lifetime Registration $ 75.00

This Includes ID Card and Pet ID Tag

ID Card for you and your Pet $ 12.50

Our Custom Made Wallet sized ID Cards are great for proving ownership and having all of your pets information safely in your wallet.

Quantity

Pet ID Tags $ 12.50

Pet ID Tags For Your Pets Collar

Subtotal $ 0.00 Shipping $ 0.00 Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please Tick *

I have read and understood the agreement
Signature *

By Signing You are stating you understand that I.P.R will be debiting your credit card for the amount requested. Clear
Should be Empty:

USA Registration Form

Emergency Contact/Secondary Owner

Breeder/Rescue

Pet Information