Your Name:

Area You Reside: (City & State)

Your Phone #: (Quicker Contact Info)

Your email address: (if available )

What Do You Know About the Manchester Terrier?
Why Do You Feel This is the Right Breed for You?
(Please state below:)

Are you interested in the Standard or Toy Variety of Manchester Terrier?
Standard Variety
Toy Variety
Puppy Only
Young Adult
Retired Show or Performance Dog
Manchester Terrier in a Rescue Program

Do you rent or own your home?
Own my home
Renting-lease allows pets. I can provide proof of signed lease.

Are there children in your household? (check all that apply)
yes, infant - toddler
yes, Pre-school Age Group
yes, Lower Elementary Age Group
yes, Upper Elementary Age Group
yes, Middle/High School Age
No children

Shipping the Puppy:
I am willing to have the puppy shipped via a domestic airline to closet major airport to my residence at my (puppy buyer) expense.
I am not willing to have the puppy shipped via an airlines to the closest airport to my residence.

Alternate method of getting your puppy to you:
I will arrange to drive to you, the breeder, to pick up the puppy
I will arrange another method that is safe for the puppy and acceptable to you, as the breeder.

How long will the dog be left home alone during the day/night?
The dog won't be left alone.
Not more than 2 hours each day/night
Not more than 4 hours each day/night
possibly 6-8 hours a day/night

How will the dog be taken care of while you are at work or away from home?
In a proper sized crate
Restricted to a 'dog safe' room in the house.
Left unattended while gone.
In a secure outdoor kennel run

Do you have a fenced yard that a dog could not jump over or dig under? **INVISIBLE ELECTRONIC FENCING IS NOT ACCEPTABLE
Yes
No, the dog will be on leash or a secure tie out when outside

Do you have other pets/animals?
Dog
Cat
Bird
Other
No other pets

Do you prefer male or female?
Male
Female
Either is fine

Are you looking for a show dog, performance dog, pet or would you consider an older puppy, a retired spayed/neutered Champion or a dog currently residing in a foster home or rescue organization?
Show dog
Performance dog
Family Pet/Companion
Older puppy
Retired Spayed/Neutered Champion
Please send me information regarding obtaining a dog from a rescue organization

Do you agree to spaying/neutering your dog if placed with you as a pet?
Yes, I agree
No

Are you willing to properly train your dog in order that it exhibits proper behavior at home and in public?
Yes
No

Do you agree to return the dog to the breeder if, for ANY reason, you are unable to keep the dog?
Yes
No

Please state any further comments you would like to make in order to help me place or locate just the right Manchester for you :)
If other pets in the home, please note how many of each you checked above.
COMMENTS: