Name:
Address:
Phone number:
E-Mail:
Personal Reference & number:
Where Will dog be kept most of the time:
Do you have a fenced yard: If not where will dog be exercised & pottied:
Do you prefer male or female and why:
Are you willing to spay/neuter? If no why:
Present & Past Pets:
Vet - address & phone #:
Would you like to be placed on a waiting list?