Your name:
Address:
Phone number:
Mobil: Your email address:
Which puppy/dog are you interested in?
What made you decide to purchase a Chinese Crested?
What interests you about the breed.
Have you ever owned or currently have a dog. Yes No
If yes, please tell us about your dog(s) including
Do you currently have any other pets.
Yes No
If so, please tell us about them.
Do you have any children. Yes No
If so, how many and what are their ages
Living Arrangements:
Homeowner Condo
If you rent, may we eventually contact your landlord to
Yes No
Please list the name(s) and phone number(s) of
How are you planning on housing this pup:
Inside Chaining
Where will your new pet sleep
What plans do you have for your new pet:
Pet/companion
Agility
If you plan to breed this dog, why
If you have no plans to breed this dog,would
Yes No
If you are unable to keep this dog,FOR ANY REASON, would
Yes No
If you answered yes,would you be willing to
Yes No
Please list 3 references, name ,home phone,
Shipping preference.
Cargo Flight companion
Please List 2 airports that are near you for
Thank you for choosing Jaya's Designer
