First Name:

Last Name:

Location (City, State/Province):

Email:

Home Phone:

Cell Phone:


1. Tell us about your family /children/ages:

2. What color do you prefer?:

3. Do you want a male or a female:Male Female

4. Do you have a fenced yard?: Yes No

5. Have you owned Poodles before?: Yes No

6. Do you have any other pets?:

7. What specific traits are you looking for in this puppy?:

8. Will you be doing agility, rally, flyball, therapy work, conformation showing with this dog?: Yes No

9. Is anybody home all day?: Yes No

10. What is the longest length of time puppy will be left alone on a daily basis?:

11. Additional Comments: