Name:
Address:
City: State:
Zip:

Home Phone: Cell :

Email Address:

Occupation:

1. How did you find us?

2. Do you prefer: MALE or FEMALE? Please explain why:

3. What color do you prefer? Please Select No preference White Cream

4. Do you want to reserve a puppy from a specific litter?
Yes No
If yes, which one:

5. Does everyone in your family want a new puppy?
Yes No

6. Does anyone in your family suffer with allergies?
Yes No
If yes, how severe?

7. Do you have children?
Yes No
If Yes, please provide their ages:

8. Will this be your family's first dog?
Yes No

9. If no, what is your level of experience with dogs?

10. Do you currently own a dog?
Yes No
Age: Breed:
Is he/she Spayed or Neutered?: Yes No

11. Do you have any other pets?
Yes No
What Types:

12. Do you have a fenced in yard?
Yes No

13. Will the puppy be home alone all day?
Yes No

14. If yes, will puppy be taken out for a mid-day break and play time?
Yes No

15. Will you continue the crate training we have started?
Yes No

16. Are you aware of the time and energy needed to care for a young puppy and willing and able to accept that responsibility?
Yes No

17. Do you have the means to budget the cost of a new puppy? (Puppy shots, monthly heartworm medication, annual vaccinations, crate, bedding, food, toys, grooming products, etc.)?
Yes No

18. Are you committed to caring for this puppy for it's lifetime?
Yes No

19. Will you be attending an obedience class with your puppy?
Yes No

20. What is the name of the veterinarian or clinic you will be using for the puppy?
Name:
Phone:

21. Have you used this vet before?
Yes No

22. May we contact them for a reference?
Yes No

24. At White English Golden Retrievers, we require the puppy/dog be returned to us - at any age - if you are unable to care for the dog. We never want one of our puppies/dogs to end up in a shelter or somewhere he/she's not wanted. We will work with families if you have the perfect home but we want to know if the dog has been re-homed.

Do you agree to notify White English Golden Retrievers first if you can no longer keep your dog or puppy?
Yes No

25. All puppies are sold on a strict NON-BREEDING - We do not allow our pet puppies to be used for breeding. Do you agree to spay/neuter your puppy by 7 months of age?
Yes No

NAME AND PHONE NUMBER OF TWO REFERENCES ARE NEEDED

Name:
Phone:

Name:
Phone:

I have answered all of the above questions truthfully. I understand that if any intentionally false answers have been given, White English Golden Retrievers reserves the right not to sell to me. By signing below, I agree to the re-home and spay/neuter policy as explained above and on the Health Warranty/Contract.

Signature:
(Type your Name as follows: First Name / Last Name)

Date:

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