City of Vergas
Chicken Application
Application
Name
Address
City, State Zip Code
Phone Number
Email Address
Number of Chickens
Select One...
1
2
3
4
Total Credit Charge
This is the total amount that will be charged to your credit or debit card:
$10.00 Chicken Application Fee
$2.00 Processing and mailing fee
$0.67 Payment Processing fee (this fee is not collected by City of Vergas)
Credit Card
Please enter your credit or debit card information here. We accept Visa, MasterCard, Discover, and American Express.
Acknowledgement
By submitting this form you certify that all the information is true and correct to the best of your knowledge, and agree to comply with any and all policies, regulations, and ordinances. Your permit may be revoked, without refund, for failure to comply with policies, regulations, and ordinances.
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