Name

Email Address

Street Address

City, ST, Zip

Phone number

Are you looking for a pet, show dog, service dog, obedience, agility, scent work, hunting? Explain:

Male, Female, Either one is fine:

Home Information: Children (ages), Married or Single, House (own or rent), Apartment

Pets: Dogs (breed, ages, sex, spayed/neutered); Cats, Birds, Other pets

Is this your first puppy, have you owned dogs in the past?