Name
First Name
Last Name
Cell Phone Number
*
Work Phone Number
*
Email
*
Name
SO?Spouse First Name
SO/Spouse Last Name
SO/Spouse Phone #
*
Spouse Email
*
Primary Address Line 1
Line 2
City
State
Zip Code
Secondary Address Line 1
Line 2
City
State
Zip Code
Rent
Rent
Own
House
House
Apartment
Condo
Urban
Urban
Suburban
Rural
How many children under the age of 18 do you have living at home?
*
Please Select
None
1
2
3
4+
Please list any children, and their first names, living in your home, their gender, and their ages.
*
Please tell us the occupations of both you and your spouse and a close estimate of the amount of money you both have per month that's left over after bills and expenses are paid in full
*
*We apologize is this seems intrusive but its only to determine whether you have the means to pay for medical bills in the event of an emergency*
How many adults, including grown children, are living in your home?
*
Please Select
1
2
3
4+
Please list all adults and their full names living in the home, their occupation, and their relationship to you, including roommates.
*
Please tell us about any pets you currently own. Please include species, breed, gender, age, spay/neuter status
*
Please tell us about any prior experience with animal ownership, including species, breed, & level of responsibility
*
Have you ever returned a puppy/dog to its breeder or surrendered a dog to a shelter or pound?
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Yes
No
If you answered "yes" above, please describe the circumstances
*
Have you ever had to put an animal down (put to sleep)?
*
Yes
No
If Yes, Please Describe the Circumstances:
*
Is someone home during the day?
*
yes
no
If no, how many hours would the pup be alone and how do you intend to provide for the feeding and exercise of the pup during your absence?
*
Where will the puppy be kept when alone?
*
Where will the puppy sleep at night
*
Are you planning to train your puppy to only go potty outside?
yes
no
Please describe your potty training expectations
*
Do you have a fenced yard?
yes
no
Please describe your yard size and fencing, or how you plan to exercise your puppy without a fenced yard. Please send Photos once you receive confirmation of your application being received.
*
What are your activity level expectations for your Yorkie puppy and as an adult?
*
Please describe any Yorkie encounters or ownership you have experienced
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What are the qualities that make a Yorkshire Terrier appealing to you?
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Please describe your ideal Yorkie
*
Please describe your knowledge of known health problems within the Yorkie breed:
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Do you have a vet who is familiar with Yorkies? Please provide the name, address, & phone #
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Yes
No
Line 1
Line 2
City
State
Zip Code
Phone Number
*
Do you have an emergency 24 hour vet? Please provide the name, address, & phone #
*
Yes
No
Line 1
Line 2
City
State
Zip Code
Phone Number
*
Please specify your preference:
Male
Female
Either
Please specify your interest in:
Pet Companion
Show/Breeding Prospect
Would you be interested in an adult re-home or rescue?
Yes
No
Do you agree to sterilize (vasectomy / spay) a Pet/Companion puppy, right at 6 months of age (females before first heat cycle but after 6 months of age and males at exactly 6 months old to prevent cancer (female) and behavioral problems (male)?
*
Yes
No
Show/Breeding Prospect Only: Do agree to have the necessary OFA clearances, including eyes, performed at 2 years of age, or earlier if we request it?
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Yes
No
Not Applicable
Show/Breeding Prospects Only: In the event that your puppy does not receive adequate OFA clearances, or for other reasons as determined by the breeder, do you agree to sterilize at that time?
*
Yes
No
Not Applicable
Show/Breeding Prospects Only: Do you agree to have the necessary health genetic testings completed per the breeds known risk factors as advised by the Breeder by the age of 1 year?
*
Yes
No
Not Applicable
What would happen to your dog in the event of major life changes (divorce, debilitating illness, job loss, etc . . .)
*
Will you commit to taking your puppy to a Puppy Kindergarten class, and at a minimum, 2 levels of obedience classes?
*
Yes
No
Do you promise to send periodic pictures and videos by posting either on the Breeder's Facebook Community page, the Breeders website or sending directly to the Breeders phone throughout the lifetime of the puppy?
*
Yes
No
If a puppy becomes available to you, would you be picking up your puppy or will you need ground transport or flight nanny services?
Please let us know if you would like a quote for ground door-to-door delivery or flight nanny door-to-door service. We also offer "meet half-way" and "meet at airport" quotes.
*
Is there anything else you feel we should know about you?
*
Please provide the names, addresses, and phone numbers of 3 personal references. Given the increase in scammers and fraudulent activity surrounding dog breeding and puppy sales, if you are unable or unwilling to provide 3 contactable references and their complete contact information, we will not be willing to sell you a puppy.
First Name
Last Name
Relationship
*
Phone Number
*
Address
*
Name
First Name
Last Name
Relationship
*
Phone Number
*
Address
*
Name
First Name
Last Name
Relationship
*
Phone Number
*
Address
*
If you are selected to receive a puppy from a particular litter, do you agree to pay a $500 non-refundable deposit at that time?
Yes
No
If for whatever reason you cannot care for your puppy during its lifetime, do you vow to give the puppy back to the breeder instead of taking the puppy to the pound?
Yes
No
If you find another person or family member to care for your puppy, do you vow to share this Breeder's contact information with them as well as inform the Breeder prior to transfer, explain why you choose this family and provide the new owner's contact information to the Breeder before transfer of ownership?
Yes
No
I, the buyer, understand that after the health guarantee expires, my puppy is nonrefundable. If I can no longer care for the animal at any time, I forfeit the right to sell the puppy to anyone. The Breeder is not obligated to pay any money for the return of the puppy to the Breeders care. The puppy will either be given to a family member or trusted friend of the buyer with Breeder's approval, or be given back to the Breeder with full rights in order to protect the puppy for the duration of its life in its entirety.
Yes
No
I agree to all conditions on this application and promise all information given on this form is true.
*
DateTime
Signature
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