ADCG01 - Dog Name Change Authorization

2018 The American Kennel ClubPermission to Use an AKC Registered Kennel name : required if part of this dog s current or new nameCustomer NumberKennel name Owner s SignatureRegistered Kennel NameBV1AC Dog name Change AuthorizationSubmit this form to request a Change to the name of an AKC-registered dog that was whelped in the USA. Please read the detailed instructions and requirements on Page 2 of this form before proceeding. name Change is not guaranteed. Processing fees are nonrefundable, and all fees are subject to Change without Fee$25 Payment InformationNote: items may be mailed separately$Total FeeVISAAMEXC harge my: Account Number (do not include dashes) _Printed name of CardholderExpiration DateMasterCardDiscoverDog name Change Only: Includes an official AKC Registration Certificate plusa Three Generation AKC Certified Pedigree$Silver PackageSilver Package: Add $19 (Save $ !) Includes an official AKC Registration CertificateDog InformationAKC Registration NumberBreed:Current AKC Registered NameNew name Requested_Owner(s) InformationOwner s First NameOwner s Last NameMailing AddressCity ZIP code + 4 State_Telephone NumberEmail Address__Co-Owner s First NameCo-Owner s Last NameMailing AddressCity ZIP code + 4 StateI (we) certify that the dog named above, for which I (we) now apply to Change the name subject to AKC requirements, has not produced or sired an AKC-registered litter or receiv

Registered Kennel Name Kennel Name Owner’s Signature Customer Number BV1AC. Dog Name Change Authorization. Submit this form to request a change to the name of an AKC-registered dog that was whelped in the USA. Please read the detailed instructions and requirements on Page 2 of this form before proceeding. Name change is not guaranteed.

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  Name, Change, The mean, Dog name change

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