NAME:

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PHONE NUMBER: Please indicate whether home or cell, best times to be reached, and if texting is an option. 

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HOW DID YOU HEAR ABOUT US?: Please let us know if you, or someone you know, has gotten a puppy from us.

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FAMILY:  Please tell us about yourself, & any others living at home; including ages & description of personalities.

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ACTIVITIES:  Please describe the activity level of your home, & things you might like to do with your new pet.

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PETS:  Please include information about any other pets currently living in your home.

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FUTURE PUPPY:  Please describe, noting level of importance, qualities you're seeking in a new family member.

GENDER:  [Male] [Female] [Either]

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BREED:  [Coton de Tulear] [Havanese] [Either]

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COLOR/MARKINGS:  

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PERSONALITY:  

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TIME FRAME IN WHICH YOU ARE HOPING TO ACQUIRE YOUR PUPPY:  

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