Pet Breeder License Renewal Application

Pet Breeder License Renewal Application
Please complete this form to apply for renewal of your pet breeder license. All information provided will be used to process your renewal request.
Full Name of Applicant
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Facility Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Current License Number
Type(s) of Animals Bred (select all that apply)
Other (please specify)
Number of animals currently at your facility
Have you had any animal welfare violations in the past year?
If yes, please provide details about any animal welfare violations or compliance actions within the past year.
Should be Empty: