Application

Please Fill Out The Form Below

Name

First Name

Last Name

Email Address

Subject

Message

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you at least 18 years of age and able to enter into a legal agreement?

Are you inquiring in a specific puppy or rescue currently available, or a breeding on the way? (If yes, provide name of puppy, or sire/dam of breeding)

Do you have a spouse or significant other? (If yes, provide name/relationship)

Do you have Children in your home or as frequent visitors? (If yes, provide Name / Age / Relationship)

Please list all pets that you currently own and/or care for - (Please provide the following for each pet: Breed / Age / Sex / Spayed / Neutered or Intact? )

Do you own or rent your home?

Rent

Own

House Type

How long have you lived at this residence? Do you have any plants to move soon?

Is your yard fenced? (Please provide details on the fence type and height)

Please indicate the size of your home and yard.

Will your dog live primarily...

Inside

Outside

Have you owned a dog before?

Have you surrended a dog? (To a pound/humane society, rescue group, etc.) for any reason? If yes, what reason?

Gender interested in...

Are you interested in a..?

Color preference? (List up to three, in order of preference)

Are you flexible on color preference?

Please give us any other additional information about yourself that will help us determine the best match for you and your family:

Do you have any additional questions or comments for us?

Current Veterinarian information

Clinic Name

Vet's Name

Phone:

Email:

How did you find our website?