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:


Address:


City:


       Zip/Postal Code:



E-mail address:


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 / are your primary reason(s) 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.


Before you click "Send," make sure you have answered all questions. Incomplete applications will be discarded without further consideration.




NOTE:
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.
 
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