1. Date:

2. Name:

3. Address:

4. City:

5. State:

6. Zip Code:

7. Phone Number:

8. E-Mail Address:

9. Best Time To Call You? Choose One 8am to 12pm 12pm to 5pm 5pm to 10pm

10. Gender Preference? Please Choose One Male Female Either

11. Size Preference? Choose One Small Medium Large Undecided

12. What Temperament Will Go Best With Your Family? Mostly Calm Mostly Active Mostly Even

13. Specific Color Preference:

14. Do You Want Your Puppy To Have Champion Blood Lines? Please Choose One Undecided Yes No

15.You know and realize all puppies are adopted with limited registration

on occasion we do adopted them with full registration. If this is something you

want you need to let us know.  Yes

If you are wanting full breeding rights we will tell you what are personal thoughts

are on the puppy, but we do not guarantee that any puppy will be show or breeding quality.

16. Do You Want A Baby That Is Listed On The Site Now ? Choose One Yes No Undecided

17. If So What Baby:

18. Which Warrantee would you like to use? Choose One Limited 1 Year Limited 5 Year

19. Do You Already Have A Vet? Choose One Yes No

20. Your Vets Name & Number:

21. Who Will Take Primary Care Of The Puppy?:

22. Do You Have A Fenced Yard? Yes No Yard But No Fence

23. Do You Have Other Pets ? Choose One NA Yes No

24. What Kind? Choose One NA Dogs Cats Cats/Dogs Other

25. How Many? 0 1-3 4-6 6+

26. Do You Have Kids? Choose One NA Yes No

27. How Old Are They? N/A 1-5 5-10 10+

28. Price Range You Want To Spend? Undecided $500-$800.00 $801-$1000 $1001-$1500 $1501-$2000

29. How Soon Do You Want Your New Baby? Undecided 1-2 weeks 2-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks

30. Do You Want To Pick Up Your Baby Or Have Her/Him Shipped? Undecided Pick Up Plane

31. What Airport Is Closes To You?:

32. Please Tell Us Why You Would Like a Puppy & List Any Questions Or Comments You Have.