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Breeder Name:* MDBA Complaints Form Breeder MDBA#:

Please fill in as much detail as you can.

All fields with a red Asterisk must be filled in.

Dogs Pet Name:

Registration number
of dog if known:

Dogs Registered
name:

Owner of dog:* Dog DOB: Complainant Name:* Complainant Phone: Complainant Email:*

Reason For Complaint (Please give as much detail as possible)

Please upload supporting documents

You MUST upload any vet reports/contracts/documents that substantiate your complaint.

You must enter the text shown in the image above into the field below.* captcha code reload Did you have your puppy/dog examined by a vet within 72 hours of arrival?: Date the complainant purchased the dog/puppy:* Did you have a written contract with the breeder of the dog/puppy?:

I agree that by submitting this form the MDBA will use all of the information I have provided to investigate this complaint and that the member against which I have made a complaint will receive all of the information that I have provided. (You must tick the box to show your agreement)*

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