NAME:      

e-mail:

TELEPHONE:  WORK:    HOME:

 HOME ADDRESS:

REASON FOR BUYING:  SHOW, AGILITY, HUNTING, COMPANIONSHIP

PREFERRED SEX:  MALE  FEMALE

INTERESTED IN BREEDING (IF NOT, SPAY OR NEUTER BEFORE 9 MONTHS)

TYPE OF HOUSING: HOUSE WITH FENCED YARD TOWNHOUSE APT.

OTHER FAMILY MEMBERS WITH AGES OF CHILDREN IF ANY:

WILL THE PUPPY BE LEFT ALONE IN THE DAYTIME? YES NO