Name________________________________________________

Address______________________________________________

City______________________State_____________Zip_________

Day Phone_________________Evening Phone_________________

Litter SIRE X Dam__________________X____________________

Preferred Gender Male_______ Female_________

Preferred Coat Color Black__________

Yellow__________

Chocolate__________

Is your deposit conditional on; Gender Preference Yes No

Color Preference Yes No

If the deposit is conditional it will be refunded if we are unable to supply the gender, or color that you have selected.

Please tell me how you will use your dog. Family pet, hunting, hunt test, field trials. Etc.

Please tell me the most important qualities you would like in a dog. Conformation, size, color, retrieving desire, nose, calm, excited, dominate, submissive, attentive to people. Etc. (use Back of form if necessary)

Will you pick pup up( ) or Have pup shipped( )

Puppies will be shipped from the Birmingham airport (BHM). Name of airport would you like the pup shipped to;

_____________________________________________________________________________

Cost of Pup____________- _____________ deposit =______________Due before delivery

Please return this form with your $100 non-refundable deposit. You will be notified of your pick number.

Date Deposit Received__________________Pick Number_________