Dam:  ___________________     Sire:  ____________________ Due date: _________

A $400.00 deposit is required to hold a puppy.  Deposits are non-refundable.

(Name) ___________________________ paid a $400.00 deposit Plus an extra $_______.00

With the remaining balance of $_______.00            Paid by:  Check #________ / Cash

I picked a (gender) __________.   Puppy will be ready for his/her new home at 8 weeks of age.

I will pick the puppy up within the first week of the ready date.

The full remaining balance is required prior to pick up.

Purchaser (owners) name: _____________________________________

Address: ___________________________________________________

City_________________________ State: _________ Zip: _____________

E-mail: _______________________________ Phone: ________________

Signatures:

Date: _____ New Owner: _______________ Breeder: ________________

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Puppies date of birth: ____________ __ Ready date for this puppy is: _______________

I picked a puppy with a (color) ____________ ribbon

Signatures:

Date: _____ New Owner: _______________ Breeder: ________________

Where did you hear about us? ____________________________________