Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Screening Questions
Do you have any experience with herding dogs?
*
Yes
No
Other
What will your puppy's primary function be? (Select all that apply.)
*
Working farm dog
Companion
Family pet
What gender puppy do you need?
*
Male
Female
Either
Will the puppy be left alone at any point and if so, for how long?
*
Will you have time to exercise the puppy daily?
*
Yes
No
Will the puppy be primarily an inside or outside dog?
*
Inside
Outside
Other
Please select the answer or answers that best describe your home?
*
Farm
Single home complex
Condo/multiplex
Apartment complex
Do you have a fenced yard?
*
Yes
No
Please select all that apply to your family/living situation? If you select either pets or children below, please also select "Other" and provide more information.
*
We own another pet/pets.
We have young children in the home often.
None
Other
How did you hear about Blue Ridge Heelers?
*
Puppies.com
Puppyfinder.com
General web search
Referred by someone
Other
If a puppy is not immediately available, do you mind waiting until a puppy is available?
*
Yes
No
Please tell us a little bit about yourself.
*
Do you have any questions for us?
By signing below, I certify that the information I have provided in this application is accurate.
*
Submit
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