Apply For a Puppy Please fill out this form to aid us in determining if you qualify for one of our puppies.  Most of the information on this form is required, so please fill it out completely.  If you cannot fill out a field, please put N/A. Personal Information Your Name: Email Address: Telephone Number: Fax Number: Address: City: State: Zip Code: Your Profession: Please list your family members and their ages:   Your history with dogs Number of dogs previously owned: Age of dog(s) when acquired: Breed(s): What happened to this/these dogs? Number of dogs presently owned: Age of dog(s) when acquired: Breed(s): Current age of dog(s) presently owned: Its/Their temperament: Gender: Spayed/Neutered: Select One Yes No   Coton and You When and Where did you learn of the Coton? Why are you interested in owning a Coton? Briefly explain why you have chosen this time to bring a new dog into your family: Gender Preference: Select One Male Female Why? What do you live in? Select One An Apartment A House Other Do you have a yard that is completely fenced without holes? Select One Yes No Approximately how large is your yard? Estimate how long your dog will be in the following: House: Yard: Other: How many hours a day are you away from home? Where will your dog be during this time? If you will be away for work or vacation, how will the dog be cared for? What type of training do you intend for this dog? Cotons have soft, cotton-like hair that requires regular grooming.  Have you used a Professional Groomer before? Select One Yes No How did you learn about Us? Select One Internet Breeder Referral Trade magazine Ad Other   References Veterinary Service: Clinic's Name: Vet's Name: Address: Phone Number: Email Address:   Groomer: Name: Address: Phone Number: Email Address:   Personal Reference: Name: Address: Phone Number: Email Address:

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