Your Name               City and State       
*Email-IMPORTANT!                         

What Happened to it?

How to reach You & Best Time

Home Phone                    
Cell Phone    

Work Phone  

*How did you hear about us?
A Friend or Relative
Dog Trainer or Club
Veterinarian
Internet Search
Google Search Advertiser
Internet Link from another Site
Newspaper Classified Ads
Dog World Magazine
Dog Fancy Magazine
Dogs USA Magazine
Puppies USA Magazine
Other (type it in the blank)

Preference:

Time Frame:

   Male
   Female
   Not Sure or either

   As soon as possible
   1 - 2 months from now
   3 - 4 months from now

Age:

Color:

In Hopes Of:

   Puppy (2 - 4 months)
   Older Puppy (4 - 8 mos.) 
   Young Adult (8 - 18 mos.)
   Adult (18+ months)
   Titled Adult
   Retired

   Black/Red
   Black/Dark Tan
   Black/Tan



 

   Show
   Schutzhund
   Elite Family Companion
   Family Watch Dog
   Obedience
   Search and Rescue

Herding
Agility
Therapy
Police
Breeding
Other

Your Status:

Other Pets:

Living Arrangements:

Dog will Reside:

   Single
   Single with roommates
   Married
   Married & 1-2 Children
   Married & 3+ Children
   Retired or Widow

   Dog Dogs
   Cat  Cats
   Birds
   Horses
   Other
 


 

   Own Home
   Rent Home
   Townhouse/Condo
   Apartment

-------------------------------
   Fenced Yard
   No Fence
   Electric fence

In the House
In the House Part-time
In the Basement
In a Kennel Building
In a Outside Kennel with a Dog House
 

We'd Like To:

Place a deposit on a certain litter.
Purchase a particular pup.
Set up an Appointment to Visit.
Speak on the phone...
    call us (815-814-5222).
 

Write it in the blank below this....