Puppy Application "*" indicates required fields Full Name* Address* City* State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP* Phone*Email* How were you referred to us? Occupation Number of Adults in your home?* Do you have children? If yes, how many and what are their ages?*Will anyone be home during the day to care for the puppy? On average, how many hours per day will the puppy be left alone? Do you have a preferred sex? If your preference is not available, are you open to the other? Do you have a preferred color? If your preference is not available, are you open to others? Are you looking for a puppy for companionship, show, agility, obedience, therapy work, or other?If for a show, have you shown a dog to its championship previously? What qualities do you like about Havanese?Is this your first dog? Is this your first Havanese? How many pets do you currently have? (Please list type, breed, age, sex, neutered or spayed)*Have you ever given a pet to a pound/shelter or given away a pet? If yes, what were the circumstances?How long did your last pet live? What were the circumstances of its death?Are you committed to caring for this dog for its lifetime? Are you willing to spay/neuter this dog? If not, why? Are you willing to sign a non-breeding contract? Do you have a fenced yard? What type of fence? If not, what are your potty plans for this dog?Have you ever potty-trained a dog? Where will the dog stay during the day/night? Are you aware that this is an "indoor" breed and cannot be left outside for extended periods of time? Are you aware of the grooming requirements for this breed? Do you plan on attending any training classes for your puppy? Any references, Vet, Groomer, etc.?Please use this space to ask any questions you have for us and to add further information you wish us to consider in placing one of our puppies with you. We would appreciate it if you would give us a little insight into the expectations you may have for this new addition to your family. Thank you again! Your interest is deeply appreciated.* REQUIREDPhoneThis field is for validation purposes and should be left unchanged.