Rafina Application

If you are interested in a Rafina Chihuahua, please complete the application below. Be sure to answer all questions; we will not respond to incomplete applications.

IMPORTANT NOTE: Do NOT place links within the form, doing so will cause an error and your application will not be sent.

Application For (check all appropriate):

Puppy Wishing Well Adult Other Adult *

* If you are interested in a specific dog or puppy you saw on our web site, you can provide that information at the end of this application.

Male Female No Preference

Your Name

Email address

Address

City

State

Zip Code

Country

Your veterinarian's name, address, phone number, and email address (if available):

Have you owned any dogs before? Yes No

If yes, where are those dogs now or what happened to them:

Have you owned a Chihuahua before? Yes No

Do children live in your home? Yes No

If yes, how many and what are their ages:

Do you own or rent your home? Own Rent

Describe your home (house, apartment, farm, other - be specific):

Do you have a fenced yard? Yes No

Are there other pets already living in your home? Yes No

If yes, please describe them:

What is your primary reason for wanting this Chihuahua (check as many as appropriate):

Watchdog Breeding Show (conformation)

Obedience Agility Pet - Companion

Other (describe below)

Please provide any additional information that you would like us to consider as we review your application. If you are interested in a specific Rafina Chihuahua puppy or Wishing Well adult, give that dog's name here, or describe which puppy & where on our web site you found the puppy's picture.

NOTE: Before you click "Send," make sure you have answered all questions. Incomplete applications will be discarded without further consideration. Your email address and name are REQUIRED! Failure to include any of those will cause form submission failure. ALSO: Make sure that you have NOT placed any links within the form as that will also cause submission failure.

Please note, if your information form is sent successfully then you will see this message

Thank You!

Thank you for your interest in a Rafina Chihuahua. You should receive an email reply from us, generally within three days, to acknowledge that we have received your submitted application. If you have any questions or concerns at any time, please contact us directly by email at rafinachihuahuas@gmail.com. Thank you again; we appreciate your interest in our dogs.

If you do not receive this message please contact Barb by email rafinachihuahuas@gmail.com

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