New Customer Registration Form

wait list application for puppy:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Do you require a male, female, or are you flexible?

MaleFemaleFlexible
Please be aware that if you would like your puppy to NOT have the tail docked, payment must be made in full at the time of birth. Docking can only be done during the first 2 days after birth.
Do you have prior experience with dogs? If so, what breeds? blanks
Do you have small children? If so, please list the age/ages here: blanks
Is there anything else that you would like me to know that has not been covered in this application? blanks .
A non-refundable $50 deposit is required to be added to the wait list. blanks
Should be Empty: