So you are interested in a Golden Meadows Puppy? Please fill this form out so we can match the right puppy to your family.

Name:

Address:                                  City:                     

State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY           Zip:    Phone:()

Referred by: Chose one Search Engine (Google, Yahoo,MSN etc) Refering website (ie Beeders.net,dog breeders.com etc) Friend L.A Times S.F. Chronicle Ventura Star O.C Registar S.B. Press Other

How many Retrievers are you acquainted with? 0 1 2 3 4 5+

What type of home do you live in? Single Family Home Townhouse Apartment Other

Do you have a Veterinarian now ? Yes No

Tell us a little bit about your leisure activities:

Tell us a little bit about yourself & family:

Do you have any children?  Yes No

            If yes, what are their ages?:

Do you own any other animals ? Yes No   If yes what kind ? None Dogs Cats Birds Other   How many ? 0 1 2 3 4 5+

Have you ever owned a dog before ?  Yes No     A Golden Retriever?  Yes No   A Vizsla Yes No

Does anyone in your family have allergies to animals ? Yes No

What type of dog are you interested in?          Choose one Golden Retriever Vizsla

What sex puppy are you interested in ? Choose one Male Female

What color puppy are you interested in ?      Choose one Golden Light Golden English Cream

What type of activity level are you looking for in a puppy ? Very High High Moderate Low

Do want to purchase a fully trained pup?  Choose One Yes No

What other attributes are you looking for in a puppy ?

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