Puppy Application
Blush Hill Biewer & Yorkies
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you understand that just because you fill out an application you are not guaranteed to be added to the waiting list?
Yes
No
Are you interested in a male or female?
Female
Male
Either Gender
Are you willing to take a puppy that does not match your stated preferences?
Yes
No
When are you looking to get a pup?
As soon as possible
within the next 6 month
within a year
not sure, in no hurry
Is this your first dog?
Yes
No
Is this your first time raising a puppy?
Yes
No
Have you ever owned a Biewer Terrier or Yorkshire Terrier?
Yes
No
Do you own any other pets in your home?
Yes
No
Do you plan to breed your dog?
Yes
No
Type of housing?
Apartment
Condo
Single family residence
other
Names and ages of all people living in your household.
Are all adults in the home in agreement to purchase a puppy?
Yes
No
Have you ever surrendered an animal to the shelter?
Yes
No
Have you or anyone in your household ever been arrested, charged or convicted for animal cruelty or animal hoarding?
Yes
No
Do you agree to contact us in the case that you need to re-home this puppy for whatever reason?
Yes
No
What Waitlist would you prefer to be on?
Notification List (Free-no guarantee)
Priority List (Limited Space) $250
Would like more information on waitinglists
None- Puppy is already selected
Are there any questions you have for us ?
By Signing below you agree that you have represented yourself honestly to the best of your ability.
Continue
Continue
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