24PW Microchip Registration Take Home Form 2016 US

*Required Field/Campo Obligatorio
Please print in UPPERCASE/Porfavor escribe en MAYÚSCULAS
Tel: 1-866-597-2424 | Fax: 1-866-738-2327
Web: www.24petwatch.com
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A B C D E F G H I
MICROCHIP IDENTIFICATION NUMBER
Affix 24PetWatch bar code label here
NÚMERO DE IDENTIFICACIÓN DEL MICROCHIP
Pegue aquí el codigo de barras de 24PetWatch
OWNER / DUEÑO (PLEASE PRINT / CON LETRA DE IMPRENTA)
First Name:*
Nombre:*
Last Name:*
Apellido:*
Address:*
Dirección:*
Unit:
Dpto.:
Zip Code:*
Código Postal:*
State:*
Estado:*
City:*
Ciudad:*
Email:*
Correo electrónico:*
Business Phone:
Teléfono del trabajo:
Tel. Home:*
Teléfono de domicilio:*
Mobile Phone:
Teléfono móvil:
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EMERGENCY CONTACT / CONTACTO EN CASO DE EMERGENCIA
First Name:*
Nombre:*
Last Name:*
Apellido:*
Home Phone:*
Teléfono de domicilio:*
Mobile Phone:
Teléfono móvil:
Other:
Otro:
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PET/ MASCOTA
Pet’s Name:*
Nombre de la mascota:*
Dog / Perro*
Cat / Gato*
Spayed / Neutered:
Esterilizada / Castrado:
Yes / Sí
No / No
Male / Macho*
Female / Hembra*
Birthdate: (MM/DD/YYYY)*
Fecha de nacimiento: (Mes/Día/Año)*
Color / Markings:
Color / Manchas:
Dominant Breed:*
Raza predominante:*
What veterinary clinic do/will you use?
¿Qué clínica veterinaria utiliza o utilizará?
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MICROCHIP PROVIDED BY / EL MICROCHIP FUE SUMINISTRADO POR
Name of Shelter / Veterinary Clinic:
Nombre del albergue o clínica veterinaria:
Address:*
Dirección:*
City:*
Ciudad:*
State:*
Estado:*
Unit:
Dpto.:
Zip Code:*
Código Postal:*
Business Phone:
Teléfono del trabajo:
I declare that the details and particulars stated in this application are true and no material fact has been withheld. I understand that misrepresentation or non-disclosure may void the services I have with 24PetWatch. Should my address and/or contact information
change, I agree to update my contact and/or address immediately at www.24petwatch.com or by calling 1-866-597-2424.
Yes, I consent to the release of my name and contact details to anyone that finds my pet.
No, I do NOT consent to the release of my name and contact details to anyone that finds my pet and I prefer that communication to me should only be through 24PetWatch.
We respect your privacy and take it very seriously at 24PetWatch. A copy of our privacy policy can be found here: http://24petwatch.com/US/General_pages/Privacy_Security.aspx In the event of questions about:
(i) access to your Personal Information (ii) our collection, use, management or disclosure of Personal Information (iii) our Privacy Policy.
Please contact 24PetWatch’s Privacy Officer by sending an e-mail to [email protected]. The Privacy Officer will investigate all complaints and if a complaint is justified, we will take all reasonable steps to resolve the issue.
From time to time Pethealth Inc., its subsidiaries, affiliates, brands, trademarks and/or partners may contact you to receive special offers, coupons, free samples, newsletters, publications, and third party promotions. Please provide your consent to the above below. You
may unsubscribe at any time.
Yes, I consent to Pethealth Inc., its subsidiaries, affiliates, brands, trademarks and/or partners may contact you to receive special offers, coupons, free samples, newsletters, publications, and third party promotions.
No, I do NOT consent to Pethealth Inc., its subsidiaries, affiliates, brands, trademarks and/or partners may contact you to receive special offers, coupons, free samples, newsletters, publications, and third party promotions.
Declaro que los detalles y la información específica indicados en esta solicitud son ciertos y que no se ha retenido ningún hecho sustancial. Comprendo que el hacer representaciones falsas o el no divulgar información pueden anular los servicios que recibo de 24PetWatch.
Si mi dirección o información de contacto cambiaran, acepto actualizar mi información de contacto o dirección inmediatamente accediendo a www.24petwatch.com o llamando al 1-866-597-2424.
Sí, doy mi autorización para comunicar mi nombre y mi información de contacto a cualquier persona que encuentre a mi mascota.
No, yo NO doy mi autorización para comunicar mi nombre ni mi información de contacto a cualquier persona que encuentre a mi mascota y prefiero que la comunicación conmigo sea exclusivamente a través de 24PetWatch.
En 24PetWatch respetamos su privacidad y la tratamos con la mayor seriedad. Se puede encontrar una copia de nuestra política de privacidad aquí: http://24petwatch.com/US/General_pages/Privacy_Security.aspx. En caso de preguntas sobre:
(i) el acceso a su información personal (ii) nuestra recopilación, uso, control o divulgación de la información personal (iii) nuestra política de privacidad.
Favor de comunicarse por correo electrónico con el Funcionario de Privacidad de 24PetWatch a [email protected]. El Funcionario de Privacidad investigará toda queja, y si una queja está justificada, tomaremos todas las medidas razonables para resolver el
problema.
De vez en cuando Pethealth Inc., sus subsidiarias, filiales, marcas, marcas registradas o socios podrían comunicarse con usted para ofrecerle promociones especiales, cupones, muestras gratis, boletines, publicaciones y promociones de terceros. Por favor, indique a
continuación su autorización a lo anterior. Puede cancelar su suscripción a estas ofertas en cualquier momento.
Sí, autorizo que Pethealth Inc., sus subsidiarias, filiales, marcas, marcas registradas o socios se comuniquen conmigo para ofrecerme promociones especiales, cupones, muestras gratis, boletines, publicaciones y promociones de terceros.
No, yo NO autorizo que Pethealth Inc., sus subsidiarias, filiales, marcas, marcas registradas o socios se comuniquen conmigo para ofrecerme promociones especiales, cupones, muestras gratis, boletines, publicaciones y
promociones de terceros.
For an online version of this form please visit www.24PetWatch.com / Para una version de esta forma en linea porfavor visite www.24petwatch.com
Shelter/Veterinary Staff: Please destroy all copies before this version 24PW-MARCH2016-US / Personal de shelter / Veterinaria : Porfavor destruir todas las copias antes de esta version 24PW-MARCH2016-US
Owner’s Signature / Firma del dueño
Date / Fecha
Mail to / Envíe por correo a: 24PetWatch Microchip Identification, PO Box 2150, Buffalo, NY 14240-2150
1) WHITECOPY - Return to 24PetWatch / COPIA BLANCA - Para devolverla a 24PetWatch 2) YELLOWCOPY - Retained by Animal Owner / COPIA AMARILLA - Para el dueño de la mascota 3) PINKCOPY - Retained by Dealer / COPIA ROSADA - Para el comerciante
The registration of your pet’s new 24PetWatch microchip will be completed in the 24PetWatch database by
shelter staff. This will allow for all pet owner information to be stored for life.
Contact the 24PetWatch team and ask about the Lifetime Membership program which allows unlimited updates to
your information for the duration of your pet’s life for a one-time fee. The lifetime fee gives you unlimited updates
including address changes or emergency contact information (online or via our call center) for the lifetime of your
pet. 24PetWatch also offers the pay as you go Annual Membership Plan. The annual fee gives you unlimited
changes (online or via the call center) for one year.
24PetWatch is dedicated to the safe return of your pet, and in order to do this they ask that you keep your account
information current by notifying them immediately with any changes.
What is the 24PetWatch microchip and how does it work?
You made a wise decision in having your pet implanted with a 24PetWatch microchip. In the event that your pet
becomes lost, your pet can be identified and reunited with you quickly and safely.
The 24PetWatch microchip is a tiny chip, the size of a grain of rice. It is permanently implanted in your pet to ensure
that it can be identified quickly. Each chip has a unique identification number that links your pet to the information you
provided today, increasing the likelihood of a quick and safe return.
The chip is not a GPS device, rather it is powered by a scanner which sends a signal to the chip and then reads the
unique identification number stored on it. When a veterinarian, or animal welfare group finds a lost or missing pet, they
use the scanner to read the pet’s chip. They then contact 24PetWatch Lost Pet Recovery Service. Once reached,
someone from the 24PetWatch team will contact the pet owner as provided on the registration and reunite them with
their pet. The 24PetWatch call center is open 24 hours a day, 7 days a week to ensure not a moment is wasted reuniting
you with your lost pet.
Keep your pet safe:
• Keep your personal information and alternate contact information up to date in the 24PetWatch Microchip
database. Notify 24PetWatch immediately of any changes to your contact information.
• Always keep a collar on your pet and be sure your 24PetWatch collar tag is securely attached.
24PetWatch is dedicated to your pet’s safety. With a comprehensive line of exclusive products and services designed to
enhance and protect your pet’s life, 24PetWatch gives you and your pet access to health, happiness and peace of mind.
24PetWatch Lost Pet Recovery Service: 1-866-597-2424
Open 24-hours a day, 7 days a week, 365 days a year.
www.24petwatch.com
Finding your lost pet:
• Call us any time, day or night and report your missing pet to one of our Lost Pet Recovery Specialists.
Once found, let us know your pet has returned safely!
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