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Obtaining an Application Kit for
Licensing or Registration Purposes

To obtain a License or Registration Application Package, please respond to the questions listed below. If you prefer, you can send your request via regular mail. The mailing addresses can be found on the bottom of the organization map page. There is no charge for the Application Package.

If you have questions regarding your need to be licensed or registered contact the respective Regional Office (Eastern Region at 919-855-7100 and Western Region at 970-494-7478) for assistance. You may also refer to our booklet Licensing and Registration Under the AWA .

To Request Forms: (Click Here)

Application Package Request: (To expedite your package, please supply all the following information.)
For a printer version: (Click Here)

Your address must contain all the information listed below.
Date: Name:
Telephone:
DBA (Doing Business As, or Business Name):
Address:
City:
State:
Zip:
County:
Region: (See organization map to determine which region handles your state.)	Eastern Western

What species of animal(s) do you own or will you be using?
What type of activity are you intending to do with the animals? (such as breeder, dealer, exhibitor, research, transportation handler, or transportation carrier)
Are you, or will you be, a traveling exhibitor? Yes or No
Do you have a previous Certificate Number? If so, please include the number in this request.

(FOR OFFICIAL USE ONLY -- ENTER NAME AND DATE OF ANIMAL CARE OFFICIAL PROCESSING REQUEST)