A SEPARATE LICENSE APPLICATION MUST BE FILLED OUT FOR EACH ANIMAL
NOTE:
Upload of Current Rabies Certificate Required To Complete This Form
Submission of a false statement is violation of applicable law for which you may be subject to civil
and criminal penalties. and which may result in invalidating a license issued.
OWNER INFORMATION
First Name
*
Middle Initial
Last Name
*
Person ID Number (If Known) :
If you received a reminder card in the mail, your Person ID # will be under your name on address label.
It will also be found on your past McKamey receipt in the upper right hand corner,
Drivers License #
*
License State of Issue
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Birth Date
*
-
Month
-
Day
Year
Date
Address
*
Address 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Primary Phone #
*
Other Phone #
Work Phone #
E-Mail
*
New License OR Renewal?
*
New License
Renewal
If Renewal, Provide Current License Number
PET INFORMATION
Name of Pet
*
Species
*
Dog
Cat
Primary Color:
*
Secondary Color:
Breed
*
Size of Pet
*
Small
Medium
Large
Age of Pet:
*
Sex of Pet
*
Male
Female
Neutered Male
Spayed Female
I have a Neutered Male & I am 65 yrs or older.
I have a Spayed Female & I am 65 yrs or older.
PROOF OF CURRENT RABIES VACCINATION
(RABIES CERTIFICATE)
IS REQUIRED WHEN PURCHASING A CITY LICENSE!
Upload Rabies Certificate:
(JPEG & PDF Files Only... 20MB MAX)
Current rabies certificate is required by law.
Attachment
*
Rabies Expiration Date
*
-
Month
-
Day
Year
Please note, your new city license will expire the last day of the month that your rabies vaccination expires.
We prefer you purchase your city license within 30 days after your pet receives their rabies vaccination.
This dog is Guard Dog Trained
No
Yes
NOTE: Guard dogs require special registration. Contact McKamey.
This dog is a Registered Service Dog
No
Yes
Total number of dogs in household:
*
Total number of cats in household:
*
Do you have MORE than 7 pets?
*
No
Yes
NOTE: $50.00 Multi-Pet Permit Is Required! Contact McKamey for Multi Pet Permit Application!
Do you breed dogs & cats?
No
Yes
NOTE: $250.00 Breeder Permit Is Required! Contact McKamey for Breeder Permit Application!
AMOUNT DUE:
$11.00
($10 + $1 postage & handling)
$51.00
($50 + $1 postage & handling)
$1.00 -
($1 postage & handling) 65 & Over - Up to 3 altered pets
CREDIT CARD INFORMATION
I authorize McKamey to charge my credit card for the amount of:
*
$51.00
$11.00
$1.00
Name On Card
*
Credit Card Type
*
VISA
MASTERCARD
DISCOVER
AMEX
Card Number
Card Number AMEX
Expiration Date
*
Month / Year: 05/2015
Security Code
*
Billing Zip Code
*
How Many License Applications Will You Be Submitting?
*
Submit
Should be Empty: