____Standard (20 lbs and over at 12 months of age)
____Miniature (11 lbs and under at 12 months of age)
____"Tweenie" ("oversized" mini between 11 and 20 lbs)
____No Preference
Gender: ___Male ___Female ____No Preference
Preferred age range:
Important: Is there anything you would like to add that would help in determining the correct animal for your living situation? Please tell us what you'd like in a dog so we may find the correct match. If you require a dog that is totally housebroken, please be honest so we do not tell you about a dog that needs some work on housebreaking. We want our dogs to be the best match for your home.
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Name, address and telephone of: Landlord (if applicable)
*Veterinarian:
Veterinarian's name, Clinic Name, Address, Phone number and email address
*References:
Must Accept collect calls in needed
*Reference 1
Name: _________________________________________
Street Address: _________________________________________
City _________________________________________
State _________________________________________
Zip _________________________________________
Phone Number _________________________________________
Email Address __________________________________________
Relationship to you __________________________________________
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*Reference 2 (Not related to you)
Name: _________________________________________
Street Address: _________________________________________
City _________________________________________
State __________________________________________
Zip __________________________________________
Phone Number __________________________________________
Email Address __________________________________________
Relationship to you __________________________________________
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*Reference 3 (Not related to you)
Name: __________________________________________
Street Address: __________________________________________
City __________________________________________
State __________________________________________
Zip __________________________________________
Phone Number __________________________________________
Email Address __________________________________________
Relationship to you __________________________________________
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Addtional Comment section:
Please review your application and make sure that you have filled in all the fields. These fields MUST be completed or else your application cannot be processed.
Your email address
Your Veterinarian's information
Reference 1
Reference 2
Reference 3
Please scroll back up and make sure these fields are filled in.
The information provided in this application (in its entirety) is true as of the date on this application. I give permission to have my references checked, am at least 21 years of age and agree that submission of this form will constitute a legally signed document.<INPUT maxLength=72 size=24 name="The information provided in this application (in its entirety) is true to the best of my knowledge as of the date on this application. I agree that submission of this form will constitute a legally signed document. (enter your name here to 'sign')">(enter your name here to "sign")
