E-mail Address: *
First Name: *
Last Name: *
Contact Phone Number 1: *
Contact Phone Number 1 Type: * Home Cellular Work
Contact Phone Number 2:
Contact Phone Number 2 Type: Home Cellular Work
Current Residence Address: *
Current City: *
Current State: *
Current Zip Code: *
Previous Residence Address: *
Previous City: *
Previous State: *
Previous Zip Code: *
Your Veterinarian's Name: *
Your Veterinarian's Address:
Your Veterinarian's City:
Your Veterinarian's State:
Your Veterinarian's Zip Code:
Your Veterinarian's Phone Number: *
Personal Reference 1 Name: *
Personal Reference 1 Address:
Personal Reference 1 City:
Personal Reference 1 State:
Personal Reference 1 Zip Code:
Personal Reference 1 Phone Number: *
Personal Reference 2 Name:
Personal Reference 2 Address:
Personal Reference 2 City:
Personal Reference 2 State:
Personal Reference 2 Zip Code:
Personal Reference 2 Phone Number:
Is your Residence a: * House Apartment Condominium Douplex Mobile Home in Mobile Home Park Mobile Home on Private Land
Do you: * Own Rent
If you rent what is your Landlord's Name:
If you rent what is your Landlord's Phone Number:
If you rent have you obtained proper permission from your landlord to house a large breed dog such as a Great Dane? Yes Not Yet
Does your residence have a: * Fenced Yard Open Yard (No Fence) Underground Fence Boxed in Patio Open Courtyard Fenced in Pet Area Yard Local Dog Park / Walking Park
Do you currently own a Great Dane: * Yes No
If you own Great Danes, how many do you currently own or house? *
Have you ever owned a Great Dane: * Yes No
If you do not own a Great Dane currently and have previously owned a dane, how long has it been since you owned one, and how long did you own that dane?
If you are approved for one of our puppies do you plan to breed your puppy when it reaches the age of maturity and want Full Breeding Rights? * Yes No
If you are approved for one of our puppies, are you prepared to place a $400 NON-REFUNDABLE deposit down on your puppy at the time of puppy selection and make additional payments on your puppy regularly until the puppy is 8 weeks old and ready to come home and is PAID IN FULL? * Yes Not Right Now
Have you fully read, understand and agree to our contract terms, health guarantee, breeding right regulations and strict return policy? * Yes No, please call me to speak about terms.
Are you applying for a current puppy now, or for a future litter puppy? * Current Puppy Availble Future Puppy from a Future Litter
If you are wanting a current puppy available now, what is the puppy's reference name or ID number?
What color are you interested in? *
What sex are you wanting? * Male Female Doesn't Matter
How did you hear about us? *
Name of Person who Referred You to Us
Place your electronic signature in the box (First, Middle and Last Name) to show that you have read and understand our contract terms, health guarantee, breeding right regulations and strict return policy. *
* Required Free Contact Form
