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Dog Registration

2. CITY OF LE MARS, IOWA - DOG REGISTRATION
4. FEE/DOG: $10.00 One (1) Year License OR $16.00 Two (2) Year License (Second Year Tag Issued)
6. OWNER NAME*
8. OWNER ADDRESS*
10. EMAIL ADDRESS:*
12. OWNER HOME PHONE #*
13. OWNER CELL PHONE #*
15. PET NAME*
16. PET COLOR*
18. PET BREED*
20. PET SEX*

    1. MALE
    2. FEMALE
21. SPAYED / NEUTERED*

    1. YES
    2. NO
22. RABIES VACCINATION:*

    1. YES
    2. NO
24. CHIP REGISTRATION #
25. CHIP MANUFACTURER NAME
27. VET CLINIC*
28. ** Please make sure to check with your Vet on keeping shots updated.
30. DATE*
32. SIGN & SUBMIT APPLICATION TO ADVANCE TO PAYMENT WINDOW
    NOTE: PAYMENT BY DEBIT/CREDIT CARD (Add $1.50 Swipe Charge + 2.35%)

    NOTE: PAYMENT BY DEBIT/CREDIT CARD (Add $1.50 Swipe Charge + 2.35%)
34. MAIL OR DROP OFF REGISTRATION
    CLICK HERE TO DOWNLOAD & PRINT PDF
36. **TAG(S) WILL BE MAILED TO THE ABOVE ADDRESS
    NOTE! Tags will only be issued if payment is received in full! Receipt of a confirmation email (only) is not proof of payment!

    NOTE! Tags will only be issued if payment is received in full! Receipt of a confirmation email (only) is not proof of payment!
38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field