Today's Date:	* required
Applicant information:
First name:	* required
Last name:	* required
Mailing address: City, State, Zip:	* required  * required
Email address:	* required
Home Phone:	* required
Cell Phone:	* required
Alternate Phone:	* required
Best way to contact you:	Email Home Phone Cell Phone Alternate Phone
Co-Applicant information:
First name:	* required
Last name:	* required
Email address:	* required
Home Phone:	* required
Cell Phone:	* required
Alternate Phone:	* required
Best way to contact you:	email Home Phone Cell Phone Alternate Phone
About Your Home:
What type of home do you live in?	Single Family Apartment Condo Mobile Home Farm
Do you have a fenced in yard?	* required
Height of fence?	* required
Type of fence:	Wooden Chain Link Electric Split Rail Concrete None
Do you Own, Rent, Other?	* required
If you rent, please answer the following 4 questions.
Does your rental agreement allow for dogs? Is there a weight limit?	* required
How much is your pet deposit?	* required
Landlord Name:	* required
Landlord Phone Number:	* required
About your family:
How many adults live in your home?	* required
Do you have any children living in your home?	* required
If yes, how many and what are their ages?	* required
Is anyone living in the home allergic to dogs?	* required
About your current pets:
Please list all pets you currently own.
1)  Please include name, type and age:	* required
2) Please include name, type and age:
3) Please include name, type and age:
4) Please include name, type and age:
5) Please include name, type and age:
Please provide any additional information on your current pets you feel we should know:
About your past pets:
Please list pets you have owned in the past 5 years.
1) Please include name, type, age and how long owned:	* required
2) Please include name, type, age and how long owned:
Please provide any additional information on your past pets you feel we should know:
What happend to the pets you no longer own?
Your Veterinarian:
Please provide information veterinary clinics who have provided medical care for your pets past and present.  Out of State veterinarians are ok. If you do not currently have pets please put which vet you plan to use.
Name of Veterinarian or Clinic:	* required
Veterinarian phone number:	* required
Some Veterinarians require that the owner calls to release information.
Will you call to give permission to release information about your pets?	* required
What owner name are the pets listed under?	* required
Pet Preferences and Care:
Why do you want to own a new pet?	* required
Do you understand that owning a pet can be a commitment of 10 to 15 years?	* required
Which pup are you interested in?	* required
Where will your new puppy live?	* required
Where will your new pet live when it grows up?	* required
How much time will your new pet spend alone?	* required
Where will your new pet stay when alone?	* required
Where will your new pet sleep?	* required
Do you consider pets part of the family?	* required
Will you have your new pet spayed/neutered?	* required
Will you take your new pet to obedience classes?	* required
How will you control fleas and heartworms?	* required
Are you financially prepared to give your new pet routine medical care? (food, Yearly check-ups and shots, monthly flea and heartworm preventative)	* required
What circumstances would cause you to give up your pet?	* required
Is there any additional information you would like to provide?
Personal References:
Reference #1 Name:	* required
Phone Number:	* required
E-Mail:	* required
Reference #2 (not a family member) Name:	* required
Phone Number:	* required
E-Mail:	* required

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