Form Tf002 - Enrollment Transfer Form printable pdf download

8051 Arco Corporate Drive, Suite 200, Raleigh, NC 27617-3900

phone: 800-252-7894 fax: 919-816-3828 e-mail: web:

ENROLLMENT TRANSFER FORM

This form is used to transfer a pet that is already enrolled with AKC Reunite. AKC Reunite enrollment will help to

ensure your lost pet’s safe return home, but does not signify ownership. There is a $19.95 fee for transferring a

pet’s record. The new Primary Contact will receive a confirmation letter once the transfer is processed.

PLEASE CHECK ONE OF THE FOLLOWING:

I am providing previous Primary Contact’s name and signature.

Previous Primary Contact’s name (print) _______________________ Signature ________________________

I am not providing previous Primary Contact’s name and signature. I understand AKC Reunite will send a release

letter to the pet’s current Primary Contact on record. This letter will request the Primary Contact acknowledge the

enrollment transfer for this pet within 30 days. If the Primary Contact approves or rejects the transfer, the pet’s

transfer will be handled accordingly. If the Primary Contact fails to respond within 30 days, the transfer will be

completed in my name.

PET INFORMATION

MICROCHIP #: __________________________________ PET CALL NAME: __________________________________________

SPECIES:

Dog

Cat

Other _________________________ BREED: ___________________________

Male

Female

DATE OF BIRTH:

__________

_ SPAYED/NEUTERED:

COLOR/MARKINGS:____________________________

Yes

NEW PRIMARY CONTACT

FIRST NAME: ________________________________ LAST NAME: _________________________________________________

ADDRESS: ________________________________________________ CITY: _________________________________________

STATE: ________________________ ZIP: ________________________ COUNTRY: ___________________________________

HOME PHONE #: __________________________________ WORK PHONE #: ________________________________________

MOBILE PHONE #: _________________________________ TEXT MESSAGE EMAIL: _________________________________

EMAIL: __________________________________________________________________________________________________

NEW ALTERNATE CONTACT

FIRST NAME: ________________________________ LAST NAME: ________________________________________________

HOME PHONE #: __________________________________ WORK PHONE #: ________________________________________

MOBILE PHONE #: _________________________________ EMAIL: ________________________________________________

PAYMENT INFORMATION: $19.95 Transfer Fee

Provide your credit card information below or enclose a check or money order, payable to AKC Reunite.

PLEASE CHECK ONE:

Visa

MasterCard

American Express

Discover

ACCOUNT NUMBER: _______________________________________________________ EXPIRATION DATE: _____________

PRINTED NAME OF CARDHOLDER: __________________________________________________________________________

CARDHOLDER ADDRESS: __________________________________________________________________________________

Please do not mail me promotions/news from AKC Reunite.

Please do not email me promotions/news from AKC Reunite.

Please do not share my information with preferred associates (third parties) for special offers regarding my pet.

Prices, programs and terms subject to change

TF002 (9/13)

Form Tf002 - Enrollment Transfer Form

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