Illinois Golden Retrievers Puppy Application

Illinois Golden Retrievers Puppy Application

Thank you for considering one of our puppies. Please complete this application so we can ensure each puppy goes to a loving and suitable home.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

About your Household
Do you have a fenced yard? If no: How will you safely provide potty and play time for the puppy?*
Do you have any pets now? (Species, breed, age, sex):*
Lifestyle and Puppy Care
Who will be the puppy’s primary caregiver?*
Are you willing to commit to: vet visits, vaccinations, grooming, training and unexpected costs?*
Puppy Preferences & Purpose
What gender do you prefer? (Male / Female / No preference)*
What type of Golden Retriever are you looking for? Please specify the parents if you can (English, American, Brazilian)*
please note: full Brazilians are expected end of 2026 spring 2027
Why are you interested in one of our Golden Retrievers?*
Are you looking for a: Family companion, Therapy/Service dog, Breeding rights (limited or full)*
When would you hope to bring your puppy home? (Month/Year)*
Commitment and Understanding
Are you prepared for a long‐term commitment (12–15+ years) with this dog? (Yes / No)*
Do you understand that if the $100 application deposit is placed it is non‐refundable ? It is included in the total purchase price*
How did you hear about us?*
Is there anything else you’d like us to know about your home, your family or your expectations?*
Application Deposit Policy
A $100 application deposit must be sent to show your commitment and interest in one of our puppies.

Before a litter list opens, we will contact everyone on the application list in the order deposits were received and give each person the option to join the $300 reservation list for that specific litter.

Please note: Not everyone on the application list will be able to get on the reservation list. Depending on what place your application is in. If you are unable to get on the reservation list you will be contacted for the next litter.

My Products*

Reservation Fee

$100.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Illinois Golden Retrievers Puppy Application

About your Household

Lifestyle and Puppy Care

Puppy Preferences & Purpose

Commitment and Understanding