NDG - Replacement registration pass

Chip number
Chip number *	Use barcode, exactly 15 characters, digits only
Holder	Fill out these fields as they are currently registered with NDG for verification purposes
Holder Type *	Professional Holder Sideline Holder Private Holder
Company *
UBN *
Name *	Initials Middle name Last name
Country *
Address *	ZIP Code House number Addition (like Bis, A or II) Street City
Email address	A confirmation will be send to this email address
Email address *
Best protection for your pet: the NDG token
Free etching and shipping! A unique token in chromed metal including free etching of name of your pet and your phone number. Within a week you will receive your personalized token. Choose between two sizes: the striking 25 mm or the elegant 21 mm, each for the same price. Protect your beloved companion with style! € 9.85 a piece, including VAT, etching and shipping.

Large (25 mm)	Order large token(s) with following etching: Use the '+' button to add more tokens. Animal name (max 14 chars) Phone number (max 14 chars) Animal name (max 14 chars) Phone number (max 14 chars)
Small (21 mm)	Order small token(s) with following etching: Use the '+' button to add more tokens. Animal name (max 14 chars) Phone number (max 14 chars) Animal name (max 14 chars) Phone number (max 14 chars)
Payment
Amount
Method *
IBAN number *
Terms & Conditions
Terms & Conditions *	I agree to the general terms of NDG
	Fields marked with * are obligatory