Application for Prospective Puppy Buyers

* = required field 
* Name *
* Street Address
* City
* State
* Zip/Postal code
* Phone
Alternate phone
* Email Address

* Reason for wanting a Doberman puppy
* Male or Female? Male  Female

Interests Pet  Show  Obedience  Agility  Other

* Have you owned Dobermans before? Yes  No
 If yes:  do you still own?  Yes  No
 If no, how died?
 Age(s) at death:
* Current pets?
 Sex of current pets: Neutered
* Cats?
* Do you have more than 1 dog in your home? Yes  No
 How many dogs do you have? 
Breeds of dogs have  

* How far will you travel to get your new puppy?

* Family members and ages

* Someone home during the day? Yes  No
* How much time would the puppy be alone?
If no one home, will you provide puppy daycare, pet sitter, other?

* Where will the puppy live?

* Do you have a fenced yard? Yes  No
  If yes... how high is the fence? 
  If no...will you provide one before your puppy comes? Yes  No
* Will you provide photo of your fenced yard? Yes  No


Current Veterinarian's Name
Vet's address
Vet phone number

A non-refundable deposit in the amount of $500 is required to reserve a Blackjack Doberman puppy.