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PLC:

a0073m

Agency:

city of buffalo city

For:

dog licenses

Phone:

608-248-2262

Address:

245 east 10th street
buffalo city, wisconsin 54622

*Required Field

Payment Information

*Name:

Middle:

*Last:

*Address:

*City:

*State:

*Zip:

*Dog Names:

*Phone Number:

(### - ### - ####)

Updated Rabies Vaccination information from Vet Clinic needed before license will be issued.

$5 per altered dog or $10 per unaltered dog If paying after March 31st add $10 per dog for a late charge

Payment Amount

*Payment Type:

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: