Name
Address
City
State		Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Country
Phone
Email
Litter Information
Litter Date of Birth		January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Sire
Sire OREBA #
Dam
Dam OREBA #
Total # of Pups
Males: Color & Markings
Females: Color & Markings

Guidelines
• A photo of the entire litter AFTER four weeks of age clearly displaying each puppy’s tail must be provided with this completed form before Puppy Certificates will be issued. These photos must be sent via separate email or preferably on CD.
• Each puppy will receive a Puppy Certificate of Registration used to identify a puppy when registering it as an adult and to transfer ownership of the puppy when sold.
• Registration using the online automated system requires the use of PayPal. To expedite the processing of your dog’s registration, we suggest using this method to pay your registration fee. If you intend to mail payment, you can complete the registration form online and print it out. You will not be able to submit it to the Registrar electronically unless you are paying with PayPal.
• If you must use the US mail, please print and send your COMPLETED registration form along with a cashiers check or money order to the address above. Personal checks WILL NOT be accepted. Any incomplete registration forms or personal checks will be returned without processing.
• In order to register a litter, the Sire and Dam must be registered with the O.R.E.B.A. The Sire, Dam, and Litter can all be registered at the same time provided that all guidelines are met. The Tail should be long and not cut or Screwed.

Payment Information:
Click here to print the Credit Card Authorization Form. For your convenience, we accept Visa, MasterCard and PayPal  (PayPal id: OREBARegistry@aol.com). Please contact us for information about payment with certified or personal checks.