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1. Today's Date (Required.)

Date

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2. Point of Contact Name (Required.)

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3. Point of Contact Email Address (Required.)

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4. Point of Contact Mailing Address (Please enter complete mailing address!) (Required.)

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5. Point of Contact Phone Number (Required.)

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6. What breed or club are you requesting kits for? Please provide specific details. (Required.)

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7. How many kits would you like? (Required.)

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8. What date do you need these kits by? (NOTE: Please allow one week per every 100 kits ordered.) (Required.)

Date

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9. Click here to download the AKC GDP submission form. Submit one form per kit.

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