index registry
 
   

   

EIDAP Registry - Secure Online Registration

 *  marks required fields


ID Information

 *  (no dashes, no dots, no spaces)
/ /

Owner Information

 * 
 * 
 * 
 * 
 * 
 *   * 
()  *  ()
() (recommended) ()
 *  Additional Email

Animal Information

 * 
 * 
 * 
Male Female Yes No
/ /

Animal Image (optional - Charge $6)

Insert File (Click on image for upload dialog)

Veterinarian Information

Search by Phone #:  ()
Clinic:   * 
If you do not find your veterinarian above please add the information here:
 * 
() ()
If the veterinarian you just listed implanted the microchip, please check box, otherwise please select from the list below:
Same
Search by Phone #:  ()
Clinic: 

Other Contact

 *  (Required field if 'Other Contact' fields are filled out)
 *  (Required field if 'Other Contact' fields are filled out)
()  *  (Required field if 'Other Contact' fields are filled out) ()
() (recommended) ()

Breeder (optional)

() ()
() (recommended) ()

Additional Information (optional)

(max 255)

Full Registration: CAD $14.00
CAD $6.00
 
TOTAL CAD $    Tax Included GST #886424050

Payment required on submission of form please Proceed to checkout

 
   
Tel: 1-888-346-8899 | Fax: 1-866-467-5160 | Email: info@eidap.com | Secure Online Registration | Privacy Policy