Countryside Golden Retrievers

APPLICATION

This application is to help us select the perfect puppy for you and your family. Keep in mind we are a small breeder. The more FLEXABLE you are about male or female the shorter the wait. ALL pups are sold on a SPAY/NEUTER contract, and with LIMITED Registration unless other arrangements have been made.Shipping runs $350-$450 depending on location. Please Send a Non-Refundable application fee of $200.00 payable to Debra Wachter along with application. Your application fee will be applied to final balance. I will e-mail you when I receive your application and application fee.

Send application to:
Debra Wachter
C/O Countryside Golden Retrievers
865 Shanghai Road
Berkeley Springs, WV 25411

NAME:__________________________________________________________________

STREET:________________________________________________________________

CITY:_______________________________STATE:___________ZIP:_______________

HOME PHONE:____________________________WORK:____________________________

EMAIL ADDRESS:_______________________________________________________

1. What gender do you prefer? Male ______ Female ________ I am flexible _________
2. Does your family have children? Y ___ N ____ Ages __________________________
3. What color do you prefur ? Light _________ Dark ________
4. Do you have other pets? Y _____ N _____ If Yes ------ Type____________________ Breed____________________ Age _______________
5. Do you have a fenced yard or a dog run? Y _____ N ______ If not, how and where will dog play and exercise?_______________________________________
6. Where will the puppy be kept during the day?_________________________________________
7. Where will the puppy be kept at night?______________________________________________
8. If you work, how long will your puppy be left alone?____________________________________
9. Is this your first dog? Y _____ N ____
10. Does your puppy need to be shipped? ______ Or will you be picking your puppy up? _____
11. Please provide descriptions of what you are looking for in a puppy. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________
12. Any additional information you feel we should know. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
I have answered all of these questions truthfully. I understand that if any intentionally false statements have been given, Countryside Golden Retrievers has the right not to sell me a puppy.

SIGNATURE________________________________________________DATE_____________

Thank You

How did you hear about us? _________________________________________________________
If Internet, what site? ________________________________________________________________