Puppy Application






Name of Applicant:


Date of Application:


Street Address:


Evening Phone:


City, State, Zip Code


Daytime Phone:


Email Address:


Referred By:



HOUSEHOLD INFORMATION:  (Please provide the following information for all members of your household.)


Relationship to Applicant

Wants to own a dog?

Home or Work Schedule

Do you have a fenced yard?

How many hours will this puppy be left alone during the day?

Other pets in the home, if so what kind?

Age of any children in the home.

Have you owned a dog before?

Have you researched this breed?

PLEASE EMAIL THIS APPLICATION TO : justamerehavanese@gmail.com

After I receive your application, I will contact you. I require a $200. Non refundable deposit to hold a puppy for you.