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We would like to thank you for filling out this form.  I have tried to ask questions that could affect the puppy in some way and also help me to get names, etc correct and help with any confusion on my part.  I show puppies by appointment only.  After I receive your information I will contact you by email or by phone call.

 

1. Please provide the following contact information:
Name

Street Address

Address (cont)

City

State/Province

Zip code

Country

Home phone

Cell Phone

Work phone

Fax

Email

2. Are you over the age of 18

Yes

No

3. Do you have children

Yes

No

4. Are you a college student

Yes

No

5. Is this your first pet

Yes

No

6. Do you have any other pets

Yes

No

7. If Yes, what kind

Dog

Other

8. What breed are you interested in

Boston Terriers Cairn Terriers Toy Poodles Other

9. Do you want a male or female

Male

Female

10. What are you wanting this puppy for

Family pet

Breeder

11. Do you agree to spay/neuter your puppy

Yes

No

12. Is everyone in your household in agreement about getting a puppy

Yes

No

13. Are you prepared to care for this puppy for the next 10-18 yrs

Yes

No

14. Do you rent or own your home

Rent Own

15. If you rent, does your lease include pets and do you have your landlords permission

Yes

No

16. Who will be the primary caretaker of the puppy

17. Do you plan on going to an obedience class with your puppy - I recommend at least a puppy class.

Yes

No

18. How many hours a day will the puppy be alone, are you able to go thru the day to take the puppy potty

19. Have you ever given a dog up to a shelter or rescue? If yes, please explain.

20. Have you lost a dog to Parvo in the last 12 months? If yes, plese explain.

21. Do you have a fenced yard

Yes

No

22. If you don't have a fenced yard, how ill you exercise & protect the dogs?

23. Do you need the puppy shipped

Yes

No

24. If yes, to what airport? give 1st & 2nd choices for major airports

25. Do you understand I take the puppies on Monday mornings for the vet checks & health certificates and ship on Tuesdays (days to ship are subject to change)

Yes

No

26. Do you understand that if you put down a deposit it is NON-REFUNDABLE?

Yes,I understand & agree to the terms?

 

 

 

 

 

 

 

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