Change of ownership dog
PET INFORMATION
Pet Name: Breed: Color/Description:
Change Of Dog Ownership Form
A fee applies*. Please see "Service Summary" and include payment details.
*If adoption papers are included, transfer fee will be waived. Adoption papers must be in new owners name.
Select Gender: M
F
Spayed/Neutered
Microchip Number: Estimated Date of Birth: Date of Last Vaccine:
PREVIOUS OWNER INFORMATION
If Adopted from a Shelter/Rescue: Please include adoption papers in new owners name in place of previous owner info or a letter from your current vet attesting to your ownership will also be accepted
First Name:
Mr
Miss Email:
Last Name:
Mrs
Ms
Home Phone: (
)
Address:
Business Phone: (
)
City:
State:
Zip:
Cell Phone: (
)
NEW OWNER INFORMATION
First Name: Last Name: Address: City:
State:
Mr
Miss Email:
Mrs
Ms
Home Phone: (
)
Business Phone: (
)
Zip:
Cell Phone: (
)
Do not release my information to anyone who finds my pet. I prefer that communication be only through 24PetWatch.
EMERGENCY CONTACT
Friends or family member we can contact in instances where owner of pet cannot be reached
First Name:
Home Phone: (
)
Last Name:
Business Phone: (
)
Cell Phone: (
)
SERVICE SUMMARY
Please choose between our change of ownership with Annual or Lifetime service. You can also order a new durable metallic collar tag that displays our Lost Pet Recovery service phone number and your pet's unique microchip ID. Simply complete the order form below including Selection and Total Amount Due.
Item Description
1. Change of ownership (includes first year membership)
2. Change of ownership (with lifetime membership)
3. Durable metallic collar tag:
Choose color: Choose shape:
# Pink # Black # Blue
# Heart
# Bone
# Green
# Gold
# Purple
# Red
Unit Price $18.95 $64.95
$11.95 each + $1.50 shipping
Selection Quantity
Total Amount Due (unit price x quantity)
Total Amount Due (please add charges, taxes may apply):
BILLING INFORMATION
Address: City: Card Holder Name: Card Number:
State:
Zip:
Phone: (
)
Visa
MasterCard
*Expiration Date:
Discover
Former Owner Signature: Date:
Please fax or mail ownership transfer form to:
P.O. Box 2150 Buffalo, NY 14240-2150 Fax: 1-866-738-2327
ownershiptransfer@
1-866-597-2424 |
Date:
New Owner Signature:
24PW-OWNERSHIP-FM0316-US
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