PLEASE TYPE IN YOUR CANINE'S MICROCHIP INFORMATION*

(All area's of the form must be filled in to activate your canine's microchip.) 

YOUR CANINE'S MICROCHIP #:

YOUR CANINE'S ACA REGISTRATION #:

YOUR FIRST NAME:

YOUR LAST NAME:

ADDRESS:

                    

CITY: STATE:   ZIP CODE:   

YOUR PHONE NUMBER:   

 YOUR E-MAIL ADDRESS:

                    (e-mail address is a required field for this form to submit)

Important information about this canine:

  

*Microchip tracking number activation is free of charge for any ACA registered canine that is registered in the ACA database and who's ownership matches the information currently on record. 

 

*The manufacturer of your canine's microchip has programmed a unique number into the microchip.  By submitting this form, that unique number will link your canine to your address on ACA's World Wide Microchip Tracking System.  This will greatly increase the chance of your canine being properly returned to your family if your canine is picked up by the local Animal Control Center.