EmailMe Form - Puppy Application

Name

First Last

Email

Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Age of applicant?

YOUR VETERINARIAN NAME

ADDRESS

CITY/STATE/ZIP

TELEPHONE#

What is your occupation?

ARE YOU INTERESTED IN

Why are you choosing a Havanese Puppy?

What other pets do you have?

Do you plan to acquire any more dogs in the next year?

Have you ever had to release a dog to rescue or back to the breeder?

What pets have you had in the past and where are they now?

How many children do you have?

THEIR AGES?

Who lives in the house? Parents, kids, grandparents, etc? *

Do you or anyone in your family have any health issues or handicaps? *

Does anyone in your house smokes? *

Where do you live?

Is your yard fenced?

YES

NO

WILLING TO FENCE IN

Are you willing to sign a spay/neuter contract?

YES

NO

Do you know how to house train a puppy?

YES

NO

Will you be able to pick up your puppy?

YES

NO

Preference on Male or Female

How will your puppy get exercise?

When your puppy is alone where will he be?

How many hours per day will your puppy be alone?

Where will he sleep at night?

What food, treats and toys do you plan to give him?

Who will groom puppy?

What flea/tick preventative do you plan to use?

What heartworm preventative do you plan to use?

Please estimate your puppy expenses per year.

Who in your family will be the primary caregiver?

When you are on vacation, who will care for your puppy?

Do you have any questions for me?

Please provide any other information about yourself or your family you’d like to share.