Name *

First Name

Last Name

I am applying on behalf of: *

Myself

My organization

Phone *

(###)

###

####

Address *

US ONLY

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cost Tier *

No Cost: • Non-Profit Organizations • Government Agencies • Active handlers in good standing with non-profit organizations or government agencies Low Cost • For Profit Organizations • Active handlers in good standing with for profit organizations • Prospective handlers with or without organizational affiliation

No Cost

Low Cost

Preferred breed *

Please select all that apply. The fewer breeds you select, the longer your procurement process may take.

Belgian Malinois

Border Collie

German Shepherd

Golden Retriever

Labrador Retriever

Other - describe below

Agreements *

I agree that all information provided above is accurate and I have not misrepresented any facts about myself or professional affiliations. I agree to allow a representative of Kaiser K9 Inc to contact me via the contact information provided regarding this application.