Waiting List Deposit Form

Please print and mail

Name:                        _____________________________________________

Address:                    _____________________________________________

                                    _____________________________________________

Home Phone:          _____________________________________________

Cell Phone:               _____________________________________________

Email Address:        _____________________________________________

Sex (check all that apply)

____  Male

____  Female

____  Will consider both sexes

Size (check all that apply)

____  Tiny Teacup (2 to 3 lbs)

____  Teacup (3 to 4 lbs)

____  Tiny Toy (4 to 6 lbs)

____  Toy (6 to 10 lbs)

____  Miniature (10 to 15 lbs)

Note:  Our puppy prices are based on size. 

Please review our puppy prices prior to making your size selection.

Colors (check all that apply)

____  White                                                 ____  Black

____  Blue                                                    ____  Silver

____  Red                                                     ____  Apricot

____  Cream                                                ____  Chocolate Brown

____  Silver Beige                                      ____  Café au lait

____  Phantom                                           ____  Black & White Parti

____  Brown & White Parti                     ____  Silver & White Parti

Other (Tell us anything else that is important to you)

___________________________________________________

___________________________________________________

___________________________________________________

Deposit Amount

Waiting List Deposits are $250.

Method of Payment

____  Check

____  Money Order or Cashier’s Check

____  Credit Card

If paying by credit card please complete:

Name on card:                    _____________________________

Credit Card Number:         _____________________________

Expiration Date:                  _____________________________

Mail Form To:  Naomi Welch, P.O. Box 2365, Aptos, CA 95001

We will contact you when your form is received and we will provide you with a receipt.