First Name
Last Name
Home Phone
Work Phone
Fax
Email
Mailing Address
City State Zip

Please give your intended uses for the pup (pet, Field Trial competitor, hunting companion, Show dog, breeding, etc.):

Please describe the pup you want:

Please describe the living situation and quarters of your new pup, including family members, pets, and ages:

Please list all dog organizations with whom you are affiliated: