* Name:
          * Address:
 * City, State, Zip:   
          * Phone #:
   * E-Mail address:

  * Children under age 6? Y N
           * Fenced yard? Y N
  * Puppy sex preference: Male Female No Preference
        * Age preference: 3 Mo. 6 Mo. 12 Mo. Adult
            * Puppy type: Show Pet
* Would you like your info made available to other approved breeders who may have quality puppies available? Y N