Name *

First Name

Last Name

Phone

(###)

###

####

Physical Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sex preferred:

Male

Female

Either

If the desired sex of puppy is not available, would you consider a puppy of the opposite sex?

Yes

No

Desired color preference:

White/ Cream

Apricot/Red

Black

Blue

Brown

Parti

Any Color

Are your current pets spayed/neutered?

Yes

No

Do you agree to spay/neuter your puppy before they are 18 months old?

Yes

No

Are you aware of the grooming needs of these types of dogs? (Grooming required every 6-8 weeks)

Yes

No

Do you have a fenced or gated area for the puppy to play safely?

Yes

No

How many hours a day on average will your puppy be home alone?

Hardly

1 - 3

4 - 8

9 - 12