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?	* 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)
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