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2. Return
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4. Pet Owner Information
6. First Name*
7. Last Name*
9. Address*
10. Apt #
12. City*
13. State
14. Zip*
16. Email*
17. Phone*
19. Description of Animal
21. Name of Dog*
23. Breed
24. License Number*
    The six-digit number engraved on your dog's tag and also found on the receipt provided to you when you licensed your dog.
26. Reason for Error
28. Reference Number*
    Please enter the Reference Number on your coupon
30. What is the error?*

    1. Dog is currently licensed (number above)
    2. No longer own dog
    3. Dog is deceased
    4. No longer resident of Maricopa County
    5. Other
32. Please Explain
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34. Submit

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