I am interested in (name of puppy):
How did you find us? (Referral from a breeder, friend, advertisement, other website, etc.)  
Your Name:  
Street Address:  
City, State, and Zip Code:
How long have you lived at this address?
Home phone number:
Cell phone number:
Work phone number:
I live in a:  
Do you rent or own your home?  
Do you have a fenced yard, if yes, what kind of fence?  
Are you planning on moving in the near future?
If you were to move, what would you do with your Bulldog?  
Are you over 21 years of age?
Are there children in the house? If yes, how many and what are their ages?  
List all of the pets you have now:  
Number of dogs:
Breed(s):
Have they been spayed or neutered?
Do they live indoors or outdoors?
Have you had any other dogs in your adult life?
If yes, how long did you own them and what happened to them?  
I want this Bulldog for (check all that apply):
How long have you been looking for a Bulldog?  
What research have you done?  
Your Bulldog will be kept mainly:
How many hours will your bulldog be left by itself in a day period?  
When you are gone, where will your bulldog stay?  
Where will your bulldog sleep at night?  
List your own personal reasons for wanting a bulldog:  
Additional comments:  
Your email address:
By clicking the submit button to the right, you herby certify that the information above is truthful and correct.