Breeder Complaint Form

Complainant Section

Complainant Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

BCA Member?*

Yes
No

Breeder Section

Breeder Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is Breeder a BCA Member?*

Yes
No

Stop Here!!! BCA does not accept complaints against Non-BCA Members.

Breeder's Division

Indicate which Division your Breeder lives in. You may locate the Divisons by clicking Here.

Phone*

Email

Sale Information

Date of Sale*

Date of Puppy Delivery*

Written Purchase Agreement*

Yes
No

Consent*

Agreement will be attached

You will receive an email of this form after you submit. Please attach a copy of your purchase agreement when mailing your form to the Breeder's Division Secretary.

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