Dam:   _________________    Sire:   __________________

Puppies date of birth:   _________________

I picked a (gender)   _______________   with a (color)  _______________  ribbon.

(Name)   _______________________________   Paid $  __________.00  by

Check #______________    /   Cash 

Purchaser (owners) name: ________________________________________

Address: _______________________________________________________

City_____________________________ State: ________ Zip: _____________

E-mail: _______________________________ Phone: ___________________

Signatures:

Date:_____ New Owner: ___________________ Breeder: ________________

Where did you hear about us? ____________________________________

If you refer us to someone and they purchase a puppy. You will receive a $50 visa card. Or If someone

else referred you to us that has purchased a puppy from us, tell us who and they will receive a $50 visa card.