Transcription of ADCG01 - Dog Name Change Authorization
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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 $ !)
in loss of AKC privileges. By supplying your email address and/or telephone number, you consent to receive communications from AKC and third parties. Processing fees are nonrefundable, and all fees are subject to change without notice. Notice. Email AKC at info@akc.org or call 919-233-9767 to speak to an AKC Customer Service Representative,
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AUTHORIZATION ACCESS, Customer, Consent, CUSTOMER CONSENT AND AUTHORIZATION FOR ACCESS, CUSTOMER CONSENT AND AUTHORIZATION FOR ACCESS TO FINANCIAL, Right to Financial Privacy Act, Federal Reserve, Access, Authorization, Cigna, CO-PAY PROGRAM, Third party, Third party authorization, AUTHORIZATION TO RELEASE INFORMATION