Jordan's Shorty Jacks Application

Name*

First NameLast Name

Complete Address (Street, City, State, Zip)*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Today's Date*

What is a good time to call and talk about your puppy?*

Gender Preference*

MaleFemaleN/A

Color Preference*

White/BlackWhite/Brown (Red)TriNo Preference

Are you currently a breeder or plan to be in the future?*

Do you have a fenced yard or other way to keep your dog safely contained? Please tell us a little about your home *

Where do you plan to keep this dog at night, and when you're not at home and how many hours a day will your puppy be alone?*

Do you have children in your home? What are their ages?*

How did you find us?

Are you aware that Short Jack Russells are both high energy and lap dogs and they do require exercise as well as time for bonding?*

I understand that there is a $250 NON-REFUNDABLE deposit to hold a puppy.*

Thank you for taking the time to fill out our Puppy Application! If you have any questions, please feel to ask here!