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PLC:

a003wn

Agency:

town of barton

For:

dog licensing renewals onsite

Phone:

607-565-2261 x5

Address:

304 route 17c
waverly, new york 14892

*Required Field

Payment Information

IF RABIES VACCINATION IS DUE, PLEASE EMAIL IT TO TOWNCLERK@TOWNOFBARTON.ORG. A LATE FEE OF $5.00 WILL BE ASSESSED AFTER 60 DAYS. PLEASE CALL OUR OFFICE IF YOU ARE UNSURE IF THIS APPLIES TO YOU.

*Name:

Middle:

*Last:

*Dog License #1:

*Dog License Type #1:

Dog License #2:

Dog License Type #2:

Dog License #3:

Dog License Type #3:

Notes:

Payment Amount

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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7820 Innovation Boulevard Suite 250, Indianapolis, IN 46278, United States

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