Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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###

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1. Preferred Puppy Gender *

Male

Female

Either

3. Preferred coat length *

Smooth

Fluffy

4. Have you ever owned a corgi? *

yes

no

5. If you have not owned a corgi, have you researched the corgi breed enough to be certain this is the right breed of puppy for you?

yes

no

6. Are you aware of the grooming care required of this double-coated dog breed? *

yes

no

7. Do you know the Pembroke Welsh corgi is a herding dog and they require daily exercise and interaction with humans and other dogs? *

yes

no

9. Do you have a fenced yard? *

yes

no

10. Will you continue to crate your puppy at night? *

yes

no

12. Are you planning to breed your puppy in the future? *

yes

no

14. Do you have children? *

yes

no

15. Have you considered, after your puppy has received ALL puppy vaccinations, to go to obedience school with your puppy? *

yes

no

18. Are you interested in being added to the $100 paid waiting list to give you preference in picking your puppy? (Picks are made in order of deposits received.) *

yes

no