Please provide the following contact information:

Name
Work Phone
Home Phone
E-mail

Gender Preference:

Male
Female

Color Preference:

Black/White  White/Grey   Red     Other      

Purpose of purchase:

Show dog
Pet

Do you own any other pets? If yes - please list below

If you own other dog(s), are they spayed or neutered? :

Yes
No
Don't have other dogs

Do you own or rent your home? :

Own
Rent

If you rent, do you have your landlords permission to keep a dog? :

Yes
No

Is your yard completely fenced in and suitable for a dog? :

Yes
No

Do you have a dog kennel? :

Yes
No

Describe fence or kennel information:

List the ages of any children residing in home:

What activities do you plan to do with this dog? :

Pet     Obedience     Agility    Confirmation

Will you take puppy/dog to training classes? :

Yes
No

Will dog be kept primarily:

Indoors
Outdoors

Do you have a regular vet? :

Yes
No

Name and number of your Vet: