Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastCell Phone * Home PhoneEmail *EmailConfirm EmailAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you Live In a *HouseApartmentRentalOtherHousehold Setting *RuralSuburbanCityDo you have a fenced in yard *YesNoWill the puppy live indoors *YesNoDo you work outside the home? *YesNoDo you have children, if so what age(s)? *Does anyone in your household have allergies If Yes list type and severity? *Have you owned a dog before? *YesNoDo you have pets now If Yes list what kinds of pets? *What gender are you looking for? *MaleFemaleNo preferenceWhat size dog are you looking for? *15-25 lbs25-45 lbs45-60 lbsLargerDo you have a veterinarian lined up for your puppy? *YesNoAre you interested in pet insurance? *YesNo, have not thought about itAre you interested in training your puppy ? *YesNoIf you answered yes in the box above what type of training? *Describe your family lifestyle *Very activeActiveModerateSedetary (chill)What would a typical day look like for a puppy/dog at your home? *Do you have a time frame for getting a puppy? *Immediately2 to 3 monthsWithin the next 6 monthsHow would you like for us to contact you with the initial welcome? *EmailTextHow would you like to do the meeting to discuss your needs personally with Beth at the Seiss Ranch? *Phone callZoomSubmit
