Name

Address

Phone (Day) Phone (Eve) E-Mail

What breed do you want Golden Retriever Labrador Color if Lab Black Yellow Chocolate

What age range would you consider? 6 wks to 6 mo 6 mo to 1 yr 1 yr to 3 yrs

3 yrs to 5 yrs Over 5 years Will you consider a mix? Yes No Maybe

Where would the dog be left when no one is home? Indoors Outdoors

Where would the dog sleep at night? Indoors Outdoors

Do you have children? Yes No If so what ages

Do you have other animals? Yes No If so what Dog Cat Livestock

Do you have a fence? Yes No If so what height is it?

Are you familiar with this breed? Yes No Owned this breed before Yes No

Were you interested in a dog currently available? Yes No If so who