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
