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Puppy Application




State or Province

Zip or Postal Code

Phone No.


What gender?
 Male Female

Please indicate which puppy you are
interested in:

Do you live in the:
 City Suburbs Country

Do you have other pets?
 Yes No

If Yes what kind?

If No, is this your first pet?
 Yes No

Do your pets travel with you?
 Yes No

Are you aware that the American Cocker
Spaniel requires grooming every 5-7 weeks
and brushed at least every few days?
 Yes No

Primary Purpose
 Pet Companion Breeding

Veterinarian's Name and No

Personal reference(s):

Note: We will not contact your references
until after a successful interview.