Form 1


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: ________________


Date: _____ New Owner: _______________ Breeder: ________________


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

I picked a puppy with a (color) ____________ ribbon


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.

Purchaser info (befor born) 1.docx