Application Form

Name Of Animal *

What Do You want? *

below, from our

Your Full Legal First and Last Name *

First

Last

City *

State *

Physical Residential Shipping Address *

Telephone Number *

Verified Email Address *

Driver license Number or State ID Number *

Zoning Compliance Confirmation *

This breed is legally permitted to possess at my residence.
This breed is not permitted in my residence.

Primary Veterinarian or Exotic Clinic Name *

Veterinary Clinic Phone Number *

Accepted Payment Method *

Bank Transfer

Binding Certification and Digital Signature. By entering your full legal name below, you certify that all information provided in this application is entirely accurate, truthful, and verified. You confirm your serious intent to secure this placement from Rare Fauna and acknowledge that providing false permit data or inaccurate coordinates constitutes a breach of our facility agreement. Your digital signature serves as a binding confirmation of your intent to purchase and your total agreement with our compliance guidelines. *

Type Full Legal Name to Serve as Digital Signature

Date of Signature Authorization *