Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Secondary Contact Number
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Would you be picking up this puppy or needing a transport service?
*
Do you Rent or Own your Home?
*
Own
Rent
If you rent, what is your landlords name?
First Name
Last Name
Landlords Phone
(###)
###
####
Do you plan on moving within the next 12 months?
*
YES
NO
If yes, what will you do with your new dog?
How many hours do you work per week?
*
Employers Phone Number
*
(###)
###
####
Tell us a little bit about you and your family!
*
Why do you want this puppy?
*
Check all that apply.
If OTHER, please explain.
Is this puppy a gift for someone?
*
YES
NO
If YES, who?
If you selected YES, who will be receiving the puppy?
First Name
Last Name
Have you previously owned a dog of this breed?
*
YES
NO
Please list all dogs you've owned over the last 10 years, their breed, their sex, if they were spayed or neutered, and if you still have them, if not please explain why you no longer have them.
*
Please list your Veterinarians Name and Phone Number.
*
First Name
Last Name
*
(###)
###
####
Do you grant Ohio Country Puppies permission to contact your veterinarian?
*
Do you grant Ohio Country Puppies permission to contact your employer?
*
