Form Center

2. 
3. Return
   Go back to ACC Home
5. Pet Owner Information
7. First Name*
8. Last Name*
10. Address*
11. Apt #
13. City*
14. State
15. Zip*
17. Email*
18. Phone*
20. Description of Animal
22. Name of Dog*
24. Breed
25. 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.
27. Reason for Error
29. Reference Number*
    Please enter the Reference Number on your coupon
31. 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
33. Please Explain
Leave This Blank:


35. Submit

* indicates a required field