Name

First Name (required)

Last Name (required)

Address

Street:(required)

City:(required)

State/Province:(required)

Zip/Postal Code:(required)

Home Phone:

Work Phone:

Cell Phone:

Your Email: (required)

Other Details

Reason for wanting a Puppy:

Male or Female: MaleFemale

Why?

Color Preference: RedBlack

CompanionShowObedienceOther

Why?

Have you owned Dobermans before? YesNo

Still owns? YesNo

If not, how did Doberman die?

Current Pets?

MaleFemale

spayed/neutered YesNo

How far will you travel to get your new puppy?

Time Frame looking for a new puppy?

Family members and ages:

How much time will the puppy be alone?

Is your yard fenced? YesNo

Height of existing fence?

Type of fence?

If no fence: will you provide one before your puppy comes home? YesNo

(No fence, no puppy)

Reference

Current or prior Veterinarian:

Address:

Phone:

Second Reference:

Name:

Address:

Phone:

All prospective puppy buyers must have a home visit by myself or an associate in their area.

When the submit button is selected you should see a thank you message below to confirm your form submission.
If this does not occur please contact Cindy Lane-Smith at: clreatta@gmail.com