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Pet Licensing Form

2. Need Help?
   If you need help with this form, please call Animal Care and Control at 817-276-4799.

   If you need help with this form, please call Animal Care and Control at 817-276-4799.

4. Owner Information

6. First Name of Owner*

7. Last Name of Owner*

9. Email address of Owner*

11. Street address where animal resides*

13. City*

14. State*

15. Zip Code*

17. Owner's primary phone number*

18. Secondary phone number (if applicable)

20. Pet Information

22. <strong>Note: You must fill out and submit this form for each pet individually.</strong>

    Note: You must fill out and submit this form for each pet individually.

24. Name of Dog or Cat being Licensed*

25. Dog or Cat?*

    1. Dog
    2. Cat

26. Colors of dog or cat*

27. Breed of dog or cat*

29. Mansfield Pet License Number

    If you have already licensed your pet, you can find this number on your city issued tag.

31. Age of animal*

32. Gender of animal*

    1. Male
    2. Female

33. Photo of the animal being licensed*

    Please upload a color photo of the dog or cat being licensed.

35. Date of Vaccination?*

36. Date Vaccination Expires?*

38. Rabies Tag #*

39. Image of rabies certificate*

    Please upload a .jpg image or .pdf of the certificate.

41. Has your pet been spayed/neutered?*

    1. Yes

    1. No

42. Image of Spay/Neuter documentation

    Please upload a .jpg image or .pdf of documentation of spaying or neutering of this animal (if applicable)

44. Date the spay/neuter was completed?

45. Which animal clinic was the spay/neuter performed?

47. Has your pet been micro-chipped?*

    1. Yes

    1. No

48. Image of micro-chipping documentation

    Please upload a .jpg or .pdf of documentation of micro-chipping of this animal (if applicable)

50. Microchip Id#

52. Would you like to pick up you're license or have it mailed to you?*

    1. Pick up the license at the Animal Care & Control
    2. Mail the license to you're address

54. Payment Instructions
    Choose one of the options below. The licensing fee is $15, but there is a $5 discount for those dogs and cats that are spayed/neutered. There is an additional $5 discount if your dog or cat is micro-chipped. Choose "0" in Quantity for each option that doesn't apply to your pet.

    Choose one of the options below. The licensing fee is $15, but there is a $5 discount for those dogs and cats that are spayed/neutered. There is an additional $5 discount if your dog or cat is micro-chipped. Choose "0" in Quantity for each option that doesn't apply to your pet.

56. Name

    Pet License

57. Price

58. Quantity*

    1. 0

    1. 1

60. Shipping Cost

61. Taxable

63. Name

    Pet License - already microchipped

64. Price

65. Quantity*

    1. 0

    1. 1

67. Shipping Cost

68. Taxable

70. Name

    Pet License - already spayed/neutered

71. Price

72. Quantity*

    1. 0

    1. 1

74. Shipping Cost

75. Taxable

77. Name

    Pet License - already spayed/neutered and micro-chipped

78. Price

79. Quantity*

    1. 0

    1. 1

81. Shipping Cost

82. Taxable

Leave This Blank:


83. Calculate Totals Proceed to Checkout

* indicates a required field