New License

* Required Fields

*License Option

• Puppy - 3 months old within last 30 days
• Dog - owned 30 days or less
• Dog - owned more than 30 days +$22.00

*Dog's Name

*Breed

*Age Years

-- Please Select --0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

*Age Months

-- Please Select --0 1 2 3 4 5 6 7 8 9 10 11

*Sex

-- Please Select --Male Female

*Color

• AP - Apricot
• BD - Brindle
• BL - Black
• BN - Blonde
• BR - Brown
• BU - Blue
• GR - Grey
• LI - Liver
• OR - Orange
• RD - Red
• SA - Sable
• TN - Tan
• WH - White
• YL - Yellow

*Hair

-- Please Select --Short Medium Long

Optional Humane Society Donation

-- Please Select --No Donation $1.00 Donation +$1.00$5.00 Donation +$5.00$10.00 Donation +$10.00$25.00 Donation +$25.00$50.00 Donation +$50.00$100.00 Donation +$100.00