Official Ear Tag Request Order Form

(Recommend using Google Chrome or Microsoft Edge browsers for full functionality.)

* indicates a required field

1. Premises Information

National Premises ID

State Premises ID

Stakeholder Name

Physical Location of Animals

Address Line 1

Address Line 2

City

State

Zip Code

County

Email Address

Phone Number

Mailing Address

Same as Physical Location

Address Line 1

Address Line 2

City

State

Zip Code

2. Stakeholder Type: (Check and enter appropriate information below)

Livestock Producer

Approved Tagging Site

Dealer/Hauler

State/Federal Staff

Accredited Veterinarian

Approved AIN Manager

3. Types of Cattle, Tags and Quantity:

	Type of Cattle	Tag	Type of tags	Quantity	Number of Tags	Notes	Delete

** Free RFID tags are only to be used in beef and dairy replacement breeding stock per USDA’s guidance

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