North American Purebred Dog Registry
Phone: 618-395-3926
Fax: 618-395-3928
Website: www.napdr.com
E-mail: napdr@napdr.com
TO
REGISTER A LITTER OF PUPS THE SIRE AND DAM MUST BE REGISTERED WITH A REGISTRY.
IF THE SIRE AND DAM ARE PUREBRED DOGS AND NOT REGISTERED THEY CAN BE INDIVIDUAL
REGISTERED WITH THE NORTH AMERICAN PUREBRED DOG REGISTRY FOR $10 EACH.
INDIVIDUAL AND LITTER APPLICATIONS CAN BE SENT IN AT THE SAME TIME. PAYMENT MAY BE MADE WITH CHECK, CASH, CREDIT
CARD, MONEY ORDER, OR PAYPAL AT napdr@napdr.com
FEE:$10.00 ($10 covers entire litter)PAYMENT MUST BE IN
PLEASE
PRINT OR TYPE:
BREED____________________________________________________________
NUMBER
OF: MALES___________________ FEMALES______________________
DATE
OF BIRTH________________DATE OF MATING______________________
DAM’S
REGISTERED NAME:___________________________________________
REGISTRY
OF DAM__________________________________________________
OWNER_____________________________
CO-OWNER______________________
FIRST M LAST FIRST M
LAST
ADDRESS:_________________________ ADDRESS:_______________________
_________________________
_______________________
CITY STATE ZIP CITY STATE
ZIP
PHONE_________________________ PHONE__________________________
E-MAIL
ADDRESS:_____________________
SIGNATURE
OF AT LEAST ONE OWNER:_________________________________
SIRE'S
REGISTERED NAME:__________________________________________
REGISTRY
OF SIRE_________________________________________________
OWNER_____________________________
CO-OWNER______________________
FIRST
M LAST FIRST M
LAST
ADDRESS:__________________________
ADDRESS:______________________
__________________________ _______________________
CITY STATE ZIP CITY STATE
ZIP
PHONE:___________________________ PHONE:_________________________
SIGNATURE
OF AT LEAST ONE OWNER:________________________________
Credit Card
#_____________________
Expiration Date______/____/______
CSC__________ (this is the
3
digit number on back of card)
Name as it appears on card
_________________________Total Amount $______________
Billing
Address__________________________________/_____________________________________
City State Zip
Home Phone_____________________ Email ___________________________
(For credit card payments,
the email field must be completed. If
you do not have one, a family member’s email address may be used. Payment confirmations are emailed