Puppy Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Will the puppy be left alone for long periods of time?
Please describe
Do you or anyone in your family have allergies to dogs?
WIll you pick up your puppy?
yes
NO
Gender preferred
Male
Female
What size dog would you like
mini
Medium
Standard
What type of Coat are you looking for
Fleece
Curly
Wool
Doesn't matter
Would you like to visit your puppy at 6 wks
Yes
No
Not sure
Have you raised a puppy before
Yes
No
Have you ever turned a dog into a shelter before
Yes
No
When would you like to purchase a puppy
-
Month
-
Day
Year
Date
Do you own your own home?
Yes
no
Do you have a fenced in yard?
yes
no
Have you reviewed our contract?
All puppies have to be spayed or neutered do you have any objections to this?
Do you have any other dogs? If so, how large and what breed?
How many children are in the home?
0
1
2
3
4
5
6+
Signature
Submit
Should be Empty: