Designer Breed Registry  Litter  Application      

                               
                                





Breed: ___________________________________________________Born:________/_________/____________

Males[      ]  Females[      ]
                                                                                                                                                                                   
Name of Sire:_________________________________________________

Breed__________________________________________Reg.#________________________(If known)
                                                                                                                                                                                     
Name of Dam:___________________________________________________

Breed:__________________________________________Reg.#_______________________(_if known)
Owner of Litter

Name:________________________________________________DBR Breeder # (if known)___________________  

Address:______________________________________________City:_____________________________________

Country/State:_________________________________________Postal/Zip Code:____________________________

Phone_______________________________  Email:___________________________________________________

Signature of Owner of Dam__________________________________________Date:__________________________

Method Of Payment
(   ) Visa     (   ) Master Card     (   )Discover   (   ) Amex   (   ) PayPal   (   )Check     (   ) Money Order           Total $25.00
Print name as it appears on credit card:

_______________________________________________________________________________  _______________
Credit Card #                                                                                                      Exp.Date                   cvc code

________________________________________________  ______/______/_____  _____________

By signing below cardholder authorizes this charge

_________________________________________________________Date___________/____________/______________

Please make checks or Money Orders Payable to: Designer Breed Registry
Mail to: Designer Breed Registry
PO Box 238
Barryton, Michigan  49305    Phone: 1-732-256-9415
Printable Page
ONLINE REGISTRATION
The DBR is not responsible for owner errors when
filling out this online registration
a correction fee of
$15.00 will apply if the registration has issued and
must be re issued.