POTENTIAL PUPPY PURCHASER'S INFORMATION:
Name:
Address:
City, State, Zip:
Home phone:
Cell or other phone:
E-mail address:
Best time to contact you:

HOUSEHOLD ENVIRONMENT:
Number of adults:
Number of children and ages:
Past pet ownership history:
Current pet ownership:
Family lifestyle: active, moderate or quiet
Will someone be home with your new puppy?
If yes, who?
If yes, when?
Facility for puppy: Yard, Fenced Yard, Pond/Lake, Acreage, Crate, Park, Unsure
Reason for wanting a Golden Retriever:

DESIRED PUPPY QUALITIES:
Puppy Character Qualities Desired:
Puppy sex: Male, Female or Doesn't Matter
Estimated Size at Maturity: Small (50-65 lbs.), Medium (65-75 lbs.), Large (75-85+ lbs.), Doesn't matter
Puppy's Energy/Activity Level: Active, Moderate, Quiet, Doesn't Matter
Dog's Intended Use: Pet, Hunting, Show
Financing Needed: Not needed, $500 down + COD, $500 down + monthly payments, Unsure
Delivery Requirements: Pick up at kennel, Local (free delivery), Pay ground transport, Pay air shipment, Not sure.
How Soon Are You Ready To Adopt: Now, Within next few weeks, Within Next Few Months, Not sure.
How Did You Hear About Us? (Nextdaypets.com, puppydogweb.com, breeders.com, puppyfind.com, Pet-classifieds.com, other)
Would You Like To Be Contacted As Our New Litters Are Born?