TiNi Bullies Puppy Waitlist

Full Name*

First NameLast Name
E-mail*
Are you 18 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Do you own your own home?*

YesNo
If not, what is your landlord's policy on pets?:
Type of Dwelling:*
What is your reason for wanting to purchase a dog?*

HousepetCompanionCompanion for petGiftOther
If other, please explain:
Are any members of your household allergic to animals?*

YesNo
If yes, please describe:
Over the past 5 years, how many pets have you owned? (Include current pets)*
Please list breed, age, if they're still living with you? (if not, why?)
If you currently own a dog or cat, how does he/she react to new dogs?
Are your present pets up-to-date on their annual vaccines?*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered?*

YesNoN/A
If no, please explain.
Can/Will you provide your dog with monthly flea/tick prevention?*

YesNo
What brand of dog food do you plan on feeding your new dog?*
Where will your dog spend most of his/her time?*
If there is anything else you think we should know, please note it here.
Phone Number

Area CodePhone Number
Should be Empty: