Personal Information



Home Phone:



Business Phone:

Website (if any):

Spouse or Second Owners Information



Home Phone:



Business Phone:

Questions for Prospective Puppy Buyer 

1. Why do you want a Havanese? 

2. For what purpose do you want this dog? 

3. Have you ever owned a Havanese before?    Y/N

    If yes do you still own the dog?

4. Do you own other pets?    Y/N

    If yes what type, how many, age & sex: 

5. Do you live in a house, apartment, condo?                        Own or Rent

6. If you rent, do you have the landlords permission to keep a dog?    Y/N

7. Are you familiar with the animal regulations in you area?    Y/N

8. Do you have a yard?    Y/N

    Is it fenced?    Y/N

   What type of fencing? 

   Is the fence enclosed to keep dog from getting out?    Y/N

9. Please list names and ages of all people (adults & children) living in 

    your household or visiting your home frequently.  

10. If you have children what has been their experience with dogs? 

11. Do all family adults work?    Y/N

12. Would someone be home during the day?    Y/N

13. What provisions would be made for your Havanese if no one is at 
      home during the day?   And, who would be letting your dog out in the middle of the day?

14. Do you primarily plan to keep your Havanese inside or outside?

15. Who will have the primary responsibility for taking care of your new puppy?

16.Where will the dog sleep?

17. Do you have a sex preference for your new dog?    Y/N

18. Color preference?    Y/N  

19. Are you willing to sign a spay/neuter contract?  Y/N 
20. Are you prepared to assume the financial responsibilities of caring for a dog, 
      including inoculations, vet care,good quality food, licensing, etc. Y/N

21. Would you agree that if our Puppy is found to be in a Pet Store or Puppy Mill we have the right
      to collect the puppy and put the puppy back in our name and possession?   Y/N

You may feel that all of the questions above are pretty silly to purchase a puppy.  But, it is very important to us to assure that our Puppies have a happy, healthy future home.  There is no way to guarantee this unless you describe the environment our Puppy would be living in.  We will not sell to Pet Stores or Puppy Mills and will do our best to make sure it doesn't happen.  So please assist us and give us as much information as you can so that we can make a qualified decision.

Please share any other information that you would like to add about you and your family that may aid in matching the right dog with you.
(photos of your yard, home, family pictures, other pets, suggested but not required) 

Thank you for taking the time to submit your request for one of our puppies.  You do not have to send a deposit with this form. We need to speak first before you send any deposit monies. 

Please e-Mail your request to Rita at  

We sell our own show-quality AKC-registered puppies, and we also provide stud services for SELECT show-quality HEALTH-TESTED HAVANESE females.
    We also offer referrals to the HAVANESE breeders we trust and respect

Have you missed acquiring a puppy from our current or last litter of puppies?

Don't miss out on the next litter:
Fill out the questions below 
and put yourself in a better position for your pick of the litter. 

Please fill out a request for a position on our list for the litter of puppies BORN NOVEMBER 19, 2012.....    

  Dear Rita:   Please put our name on your waiting list for your next litter of puppies.

     Name_____________________ Address____________________ City,State___________Zip_______

Secure your Puppy request in advance by filling out our Puppy Request Form and talking to the Breeder.  
Indicate if you are interested in a Companion Puppy______ or a Potential Show Puppy__________ 

Male ______  or Female_______                           Phone number:_________________________   
Puppy Request Form