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Puppy Interest Form

About you:

 Name
Address
City
State
Zip
Day Phone
Eve Phone
E-mail

Enter the number 17 in this field (to exclude bots and spammers) 

Your occupation: 

Your age: 

Number of adults in your household: 

Number of children in your household (include visitation, day care): 

Please describe your living situation, checking all that apply:

House                                                                                          
Apartment
Condo/townhouse
Suburban
Urban
Rural
Fenced yard
Unfenced yard
No yard -- I'll be walking!

What other pets do you currently own? 

Why do you want an English Cocker (rather than another breed)?


If you have had an English Cocker before, from whom did you purchase him/her?


What is your primary reason for wanting a dog? 

What gender do you prefer? 

Would you consider either gender, if your preference is not available? 

Please indicate what colors you will accept:

Blue Roan
Blue Roan and Tan
Orange Roan
Black and White
Orange and White
Black, White and Tan
All are OK -- no preference

Please tell us anything else we should know about you or your search for an English Cocker.