UCA Online Single Dog Registration Application

UCA Single Dog Registration Application

UCA Single Dog Registration Application

Do not use this form if you have a "Temporary Puppy" registration certificate provided by the breeder.
The original document provided by the breeder must be signed by the breeder and mailed in to our office.
When submitting this application it is required to email 3 photos of the dog to be registered to the following address: register@ucadogs.com
Please include any additional information such as photo copies of previous registration and/or pedigree information.

   Breed of Dog: *

   Name of Dog to be Registered: *

   Bloodline:

   Colors / Markings:

   Sex: *
Male

Female

   Date of Birth: *

MM /
DD /
YYYY

   Name of Owner: *

First
Last

   Owner's Phone Number: *

### -
### -
####

   Owner's Email Address: *

   Owner's Address: *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country

   Name of Breeder:

First
Last

   Breeder's Phone Number:

### -
### -
####

   Breeder's Email Address:

   Breeder's Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country

   Name of Sire (Father): *

   Sire's UCA Reg. Number:

   Name of Dam (Mother): *

   Dam's UCA Reg. Number:

   Registration Options: *
$20 - Certified Registration Certificate

$35 - Certified Registration Certificate with Photo

       Please Provide Photo when Needed

   Laminated Certificate:
$8 (Additional)

   Pedigree Options:
$15 - 3 Generation Pedigree

$25 - 3 Generation Pedigree with Photo

$25 - 4 Generation Pedigree

$35 - 4 Generation Pedigree with Photo

$35 - 5 Generation Pedigree

$45 - 5 Generation Pedigree with Photo

       Please Provide Photo when Needed

   Laminated Pedigree:
$8 (Additional)

   Rush Processing:
$10 - Rush Processing (5 Business Days)

$15 - Super Rush Processing (3 Business Days)

   Pet Photo Identification Card:
$8 (Laminated)

   Conformation Show Quick Entry Card:
$5 (Laminated)

   UCA Logo Window Decal:
$8

   Canadian / Overseas Mailing:
$5

   Total Payment Due: *

Please contact UCA (417) 924-2291 to make required payment if not using your a debit / credit card.

All applications are destroyed within 48 hours if payment is not received.

   Credit Card Number:

   Credit Card Expiration Date:

   Credit Card Security Code: (3 digit number on the back of the card)

   Name on the Card:

   Additional Information:

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