1. Date:

2. Name:

3. Address:

4. City:

5. State:

6. Zip Code:

7. HOME/Land Line Phone Number ONLY:

8. E-Mail Address:

9. Best Time To Call You? Choose One 8am to 12pm 12pm to 5pm 5pm to 10pm

10. Gender Preference? Please Choose One Male Female Either

11. Size Preference? Choose One Small Medium Large Undecided

12. What Temperament Will Go Best With Your Family? Mostly Calm Mostly Active Mostly Even

13. Specific Color Preference:

14. Do You realize we only Place companion Pets? Please Choose One Yes No

15. Is every one in your home ready for a fur child? Choose One Yes No

16. Do You Want A Baby That Is Listed On The Site Now ? Choose One Yes No Undecided

17. If So What Baby:

18. Have you read our health warrantee?   Choose One Yes No

19. Do You Already Have A Vet? Choose One Yes No

20. Your Vets Name & Number:

21. Who Will Take Primary Care Of The Puppy?:

22. Do You Have A Fenced Yard? Yes No Yard But No Fence

23. Do You Have Other Pets ? Choose One NA Yes No

24. What Kind? Choose One NA Dogs Cats Cats/Dogs Other

25. How Many? 0 1-3 4-6 6+

26. Do You Have Kids? Choose One NA Yes No

27. How Old Are They? N/A 1-5 5-10 10+

28. Price Range You Want To Spend? Undecided $1001-$1500 $1501-$2000

29. How Soon Do You Want Your New Baby? Undecided 1-2 weeks 2-4 weeks 4-6 weeks 6-8 weeks 8-12 weeks

30. Do You Want To Pick Up Your Baby Or Have Her/Him Shipped? Undecided Pick Up Plane

31. What Airport Is Closes To You?:

32. Please Tell Us Why You Would Like a Puppy & List Any Questions Or Comments You Have.

*Credit Card NO CHARGE BACK POLICY*

I the person on this letter have paid for a Puppy using my Credit Card I agree to fore go ANY charge back for ANY reason under their NO REFUND policy. I understand any problems will be dealt with outside of a charge back credit directly with Love Puppies 4 U/Shorkie World. I Understand I will NOT be credited back on my Credit Card account for any reason if I cancel the sale, or are dissatisfied with purchase. I will get refund any money charged by check when proof of refund is deemed necessary. Buyer's acceptance of any animals agrees that this transaction was consummated within the state of Missouri and consents to the application of all Missouri Laws and to the jurisdiction of Missouri Courts. Should a dispute arise out of this transaction. Buyer further agrees that should he default in any obligation of this agreement, he shall be responsible for all attorney fees and court costs involved in the prosecution of this action. Acceptance constitutes An agreement to pay the above listed price and totals, with in agreed terms.

33. Have you read and agree to the "NO CHARGE BACK" policy Yes