Microchip — Purrfect Pawprints

Purrfect Pawprints
Microchip Contract

Thank you for choosing to microchip your pet!

Animal Information

Pet Name:

Microchip #

Species

Gender

Breed:

Approximate Age:

Description:

Payment Form

Last 4 of CC#

Owner Information

All form agreements must be completed by the owner. By submitting this agreement/contract, the owner is certifying that this is their true and accurate personal information.

Name of Owner

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number

(###)

###

####

Alternate Phone Number

(###)

###

####

Used to register microchip.

Agreement

This contract is made between Purrfect Pawprints and the adopter(s). By submitting this form, electronically, or otherwise, I certify that I, the adopter, am personally completing these agreements and agreeing to all of the terms on the form. I acknowledge that the terms also apply to any current or future family members or representatives, and acknowledge receipt, from Purrfect Pawprints, of the animal described herein.

I hereby authorize and direct Purrfect Pawprints Animal Rescue Inc. to implant a microchip in my pet. I fully release Purrfect Pawprints, its volunteers, and its agents from any legal and financial responsibilites, claims, demands, damages, or actions arising from microchipping.

I agree

Purrfect Pawprints Representative

first & last name of witness/associate

Date of Microchip Implant

YYYY

Is your pet spayed/neutered

yes

Purrfect Pawprints
Microchip Contract

Applications & Forms

Action

Contact
Donate
AppLy to foster

Purrfect PawprintsMicrochip Contract

Purrfect Pawprints
Microchip Contract