Designer Breed Registry                                                                                                                Order Litter Certificate   
                                                          




INFORMATION                      


Name                                                                                                                Breeder Number                    Litter Number                                      Date of Birth

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Breed of Puppies                                       Sire:                                                                                                  Dam

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Address                                                                                                                      City                                                      Country/State    

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Postal/Zip Code                                              Phone                                                                       Email

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                                                                                            Payment

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 Certificate $25.00

Name on Credit Card______________________________________________________________
Account Number                                                                                                                                 Exp. Date                        cvs code
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Billing Address if different than mailing address                                        City                                                 State/Country
International Orders please add an additional $5.00 for shipping and handling  
Send completed application to:
Designer Breed Registry/ Registered Kennel Name
PO Box 238
Barryton, Michigan  49305
1-732-256-9415