PUPPY ADOPTION APPLICATION - Send with DEPOSIT to Address at bottom

Please PRINT Out, Fill In and MAIL via U.S. POST OFFICE with Deposit

Also print out Warranty , Sign and Return with This Application

Date Litter

Owner (Buyer) Co Owner -if any
Mailing address
City State Zip
Home PhoneWork Phone Fax
Email address

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Check as many as apply:
Pet- Obedience competition- Hunt Tests- Field Trials- Agility- Search & Rescue- Hunting companion-Therapy Dog- Service dog- Breeding- Freestyle- Conformation- Name other uses, if necessary

MALE- FEMALE- ------If necessary, will you take the opposite sex? Yes- No-

REGISTRATION: Limited- Full- * Refer to Litter Information under - Price & Deposit * email us for details Limited Registration means that the puppy is registered but no litters produced by that dog are eligible for registration. This AKC procedure helps protect established breeding programs. These dogs can be shown in obedience trials, field trials, and hunt tests.We ask for a $200 deposit to reserve puppies. Litters generally sell quickly

Color preference: Red- Medium Gold or Copper- Light Gold- Very light-No Preference-

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If children in household, give their ages:

Other Pets in household:

Will this pup be neutered: if no: Why not:

Mailing Address: Jackie Mertens

Rt 3 Box 193 - Madison, FL 32340
PH # (500) 445-5170 / Fax # (850) 929-7504

or PH(850) 929-7502