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2. Need Help?
   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. 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 your license or have it mailed to you?*

    1. Pick up the license at the Animal Care & Control
    2. Mail the license to your 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.
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

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