Your Name

Address

City

State

Zip Code

Home Phone

Cell Phone

Best time to call

E-mail

What age dog are you interested in? Don't care about age Puppy (under 6 mos.) Young Adult (6-18 mos.) Adult

What sex are you interested in? Either male or female Male Female

Where do you live? House (owned) House (rented) Apartment/Condo (owned) Apartment/Condo (rented)

Check if you are willing to spay/neuter your new dog

If you live in rented housing, check here if you have your landlord's permission to have a dog

Tell us why you would like to own a Havanese Oops, forgot this one!

Check here if you have children under the age of 18

Have you ever owed a dog before? What kind and what happened to it? Oops, Forgot this one!

My family is Very active Moderately Active Laid back Couch potato (this is not a bad thing)

Check here if your yard is fenced

What do you plan to do with your new dog? Treasured Pet Conformation/Show Agility Obedience Other dog sports

Do you own any other animals?  What kind and how many? Oops, Forgot this one!

Anything else you'd like us to know