1. 92 Bedford Road Merrimack, NH 03054 (603) 493-8046 Phone (603) 424-8915 Fax Puppy Application Tell me about Yourself Name:_________________________________________________ Address:_________________________________________________ _________________________________________________ Home Phone: _________________________ Work Phone / Cell Phone: ________________________ E-mail Address:_____________________________________________________________________ Occupation:_____________________________________________________________________ Hours Worked:_____________________________________________________________________ Tell me about where you live Type of Dwelling:HouseCondoApartment Mobile Home How long have you lived at this address?_____________________________________________ If renting, does your landlord allow dogs?_____________________________________________ Do you have a fenced-in yard? If so, how large:_____________________________________________ If not, will you be willing to install one prior to bringing your new puppy home? ______________ Are there any other pets living in the home?____________________ If so, name the type and age of the pet: ____________________________________________________________ Are there any children living in the house? If so, what are their ages: _____________________________________________________________________________________________ ____________________________________________________________________________________________ Choosing a puppy Referred by:_____________________________________________________________________ Why are you choosing our little goldens?_________________________________________________________ Which litter are you interested in?_________________________________________________________ Do you prefer a male or female? Please explain why: _________________________________________________ _____________________________________________________________________________________________ If your first choice is not available, would you be willing to take one of the opposite sex? _____________________

2. Page 2 Are you ready for a dog? Who will be the primary caregiver:________________________________________________________ Why have you chosen this breed?________________________________________________________ Have you ever owned a dog? If so, when and what breed:___________________________________ Are you aware of the pros and cons of this breed? __________________________________________ Do you intend to crate-train your dog?_______________________________________________ Have you ever house-trained a dog before?_______________________________________________ What are you looking for in a puppy/dog?_______________________________________________ Does anyone in the home have any allergies to dogs? If so, how severe are they: __________________ ____________________________________________________________________________________________ Who will groom your new puppy/dog and how often? _______________________________________ Are you aware of the expenses of having a dog: food, vet bills, training, etc? _____________________ Do you agree to feed this dog premium dog food for its optimal health? _________________________ Will you provide this dog with the best medical care when needed? ____________________________ Do you agree to have your dog spayed or neutered within the first 6 months? _____________________ What Veterinarian will you be using? Please provide the name, address and phone #: ____________________________________________________________________________________________ Some other questions for you Where will the puppy be kept during the night?____________________________________________ When not at home, where will the puppy be kept? __________________________________________ Is anyone home during the day?________________________________________________________ On average, how many hours will the puppy be left alone:___________________________________ Will there be anyone available to feed and exercise the puppy during the day? ___________________ What do you expect the activity level of this breed to be: Very High High Moderate Below Average When your dog is outside, how will he be confined? ________________________________________ Have you ever returned a pet to the breeder? If so, what were the circumstances? __________________________ ____________________________________________________________________________________________ Have you ever taken a pet to a pound or shelter? If so, what were the circumstances? _______________________ ____________________________________________________________________________________________

3. Are you interested in showing the dog in the conformation ring? ___________________________ Are you interested in competition events such as obedience, agility, hunting, etc? __________ Do you intend to breed the dog? ___________________________ Do you understand the difference between “Limited Registration” and “Full Registration”? ________ Are there any major changes in your life in the near future such as divorce, moving, new job, new baby, or other such situations? If so, explain: ___________________________________________________ ____________________________________________________________________________________________ Do you agree to NEVER leave this dog outside in extreme weather? _________________________ Do you agree NEVER to chain this dog to any stationary object, such as post, tree or leave it in the garage? ________________________________________ Do you agree to NEVER let this dog run off leash in an unfenced, unsecured area? ____________ Do you agree to use only positive re-enforcement training with this dog? ____________________ Do you agree to NEVER use electronic collars on this dog? ______________________________ Do you plan to title this dog in any way, and if so, for what? _____________________________ In the event that you are unable to keep this dog, would to give the breeder first option to take it back? _________________________ Please provide three references that we may contact; their names, phone numbers and/or e-mail address: ________________________________________________________________________________ ________________________________________________________________________________ All of our pet/companion puppies are sold with AKC Limited Registration and spay/neuter contracts. This means that the dog is registered with AKC however, none of the offspring are eligible for registration. A dog with a Limited Registration as well as a spayed or neutered dog can compete in all AKC events except Conformation (breed ring). I swear that by submitting this application that the content is the truth and to the best of my knowledge. I also understand that by submitting this application, it does not guarantee me a puppy, all potential buyers must also be interviewed by the breeder prior to approval. Signature of Applicant:____________________________________ Date: _____________________ Page 3