List My Dog/Puppy
Contact Person:
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First Name
Last Name
E-mail
*
Phone Number
*
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Area Code
Phone Number
Kennel or Rescue Name
Company Website
Type of Dog/Puppy
*
Male or Female
Please Select
Male
Female
Date of Birth
Date Available
Deposit Amount
Deposit Refundable
Yes
No
Total Cost
Shots Given
Please Select
Yes
No
If Yes Please List Type & Brand of Shots
Wormer Given
Yes
No
If yes on Wormer Please give brand ages when administered
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Prefered Contact Method
Phone
Email
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All the above
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