Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you prefer Male or Female?

Male

Female

No Preference

Have you ever owned a dog?

Yes

No

Do you agree to sign a non-breeding contract?

Yes

No

Do you agree to have your puppy spayed or neutered?

Yes

No

Do you currently have a vet?

Yes

No

Do you have a fenced in backyard?

Yes

No

How did you hear about us?

Facebook

Kijiji

Friend

Other