1. Date:

2. Name:

3. Address:

4. City:

5. State:

6. Zip Code:

 We must have a phone number to contact you. We taking placing our babies very seriously.

 NO Baby is placed with out personally talking to you. If you submit this form with out a number it will be deleted Sorry.

7. Home Phone Number & Cell Phone Number:

You must give us your home number Land Line....

8. E-Mail Address:

9. Gender Preference? Choose One Male Female Not Sure

10. Is every one in your home ready for a new puppy? Please Choose Yes No  

11. Do you Own or Rent your home:? Please Choose One Rent Own

12. If you Rent do you have permission from your landlord to get a puppy?: Please Choose One Yes No not yet No

13. Do You realize your baby will be VERY PRE-SPOILT? Please Choose One Yes No

14. I Knowledge that Shorkie world places/sales ONLY companion pets. Yes

15. Do You Want A Baby That Is Listed On The Site Now ? Choose One Yes No Undecided

16. If So What Baby:

17. Have you read our health warrantee? Choose One Yes No

18. Do You Already Have A Vet? Choose One Yes No

19. Your Vets Name & Number:

20. Who Will Take Primary Care Of The Puppy?:

21. Do You Have A Fenced Yard? Yes No Yard But No Fence

22. Do You Have Other Pets ? Choose One NA Yes No

23. What Kind? Choose One NA Dogs Cats Cats/Dogs Other

24. How Many? 0 1-3 4-6 6+

25. If you have other dogs what breed are they?:

26. Do You Have Kids? Choose One NA Yes No

27. How Old Are They? N/A 1-5 5-10 10+

28. Price Range You Want To Spend? Undecided $900-$1100 $1101-$1500 $1501-$2000 $2000.00 and Above

29. How Soon Do You Want Your New Baby? Undecided 1-2 weeks 2-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks

30. Do You Want To Pick Up Your Baby Or Have Her/Him Shipped? Undecided Pick Up Plane

31. What Airport Is Closes To You?:

32. Please Tell Us Why You Would Like a Puppy & List Any Questions Or Comments You Have.