Name *

First Name

Last Name

Phone Number *

(###)

###

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Address (Please include your full address). This is used for mailing puppy registrations. *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Puppy Preference (check all that apply)

Male

Female

No preferance in sex

Blue Merle

Red Merle

Black Tri

Red Tri

No color preferance