InfoPET

    

InfoPET National Registry Database Registration Form

1. Enter your pet's Microchip ID Number (InfoPET registers all brands of microchips):*

InfoPET/Trovan/AKC/HomeAgain/Other Microchip (10 characters: 0-9 and A-F; such as 0006CB12A3)

                                       OR

AVID Microchip  (9 digits: 0-9; such as 002345678)

                                       OR

ISO Microchip    (15 digits: 0-9; such as 981002345678901)

2. Enter the date your pet was microchipped:

Date your pet was microchipped   -- mm/dd/yy

3. Provide the following Pet Parent(s) contact information (Note:  We recommend your pet be registered in both spouses' names to permit either person to make information changes in the future.):

First Name(s)* (Max of 25 characters)
Last Name* (Max of 25 characters)
Street Address* (Max of 35 characters)
Mailing Address (if different) (Max of 35 characters)
City* (Max of 25 characters)
State/Province*
ZIP Code*
Daytime Phone* --
Evening Phone --
Cell Phone --
Other Phone --
E-mail Address (Max of 30 characters)
Password for Internet access to your pet's information (8-16 alphanumeric characters: 0-9 and A-Z)

4. Provide the following Alternate Contact (such as Friend, Neighbor or non-spouse Family Member) information:

First Name (Max of 25 characters)
Last Name (Max of 25 characters)
Daytime Phone --
Evening Phone --
Other Phone --

5. Provide the following Veterinary Clinic contact information:

Veterinary Clinic Name (Max of 40 characters)
Veterinary Clinic Phone --

6. Identify and describe your pet:

Pet's Name* (Max of 25 characters)
Species* Dog   Cat   Bird   Horse   Rabbit  Reptile  Other
Sex* Male       Female
Spayed/Neutered?* Yes          No           Unknown
Breed* (Max of 35 characters)
Date of Birth -- mm/dd/yy
Color* (Max of 50 characters)

7. Enter optional Medical Information & Medications for your pet in the space provided below.

(Max of 250 characters)

8. Enter the date of your pet's last Rabies Vaccination:

-- mm/dd/yy

9. Enter any additional information about your pet or you -- to help InfoPET quickly & safely return your lost pet home.

(Max of 250 characters)

10. Enter credit card payment information*:

Visa     MasterCard      

Credit Card Number*  -   - -

Credit Card Verification Code*  (Printed in signature area on back of credit card:  Last 3 digits)

Name on Credit Card (i.e., issued to)*

Expiration Date* -- mm/yy          Billing Address ZIP/Postal Code

Is this your first pet registered with InfoPET?*  

          Yes     Pet lifetime registration fee of $25 will be charged to your credit card

           No      Pet lifetime registration fee of $10 will be charged to your credit card, but you must provide microchip number(s) of other pet(s) already registered with InfoPET below OR brass collar tag number(s) (6 digits) of other pet(s) already registered with InfoPET:

                          Pet 1               Pet 2             Pet 3   

                          Pet 4 

* - Required information

                                                                                

Note:  A Registration Confirmation screen will appear after you click on Submit Form.

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