St. Louis County Department of Public Health Annimal Care & Control
Rabies Tag Order Form
Clinic: Address: Phone: Tag Type
Quantity
Cost
Total
1 Year Altered
$8.00/tag
$ 0.00
1 Year Unaltered
$16.00/tag
$ 0.00
3 Year Altered
$20.00/tag
$ 0.00
3 Year Unaltered
$40.00/tag
$ 0.00
Grand Total:
$ 0.00
For office use only Date:
Indicate supplies needed
Receipt #
Certificates
Payment:
Envelopes
Check #
“O” rings
⊕ Visa
⊕ MasterCard
⊕ Cash
This form will be used as an internal receipt. Before any other tags can be issued, this tag order must be paid in full. Date ordered: Date Processed: Signature: Today’s Date:
⊕ Mailed ⊕ Picked up