Name:
Address:
City:
State:
Zip Code:
Phone Number (H):
Cell Phone:
Email Address:
Customer Information:
Puppy Information:
Puppy Interested In:
Will We Need to Ship?
If Yes, Airport Choice:
#1 Choice:
#2 Choice:
Which Method of Payment do You Prefer?
Paypal Email Address, if Applicable:
Questions/Comments:
Please complete the puppy application and you will be contacted within 24 hours.
Feel free to call anytime.
417-825-9302
I have read the "Health guarantee", "Bringing Puppy Home", and "Payment" pages and I understand all information regarding this puppy.  By submitting this form, I agree to the document in full.   I certify that I am 18 years of age or older, and I am authorized to use the payment method selected. 
Puppy Application
Would You Like the "AKC Puppy Protection Package?
This includes AKC registration and microchip.  Before clicking yes, please view package information to the right.
There are no puppies available at this time, I would like to be added to your waiting list:
If you chose the Puppy Protection Package, please complete this section.  If you did not choose the package, please scroll to the bottom and click "Submit".
New Owner(s) Name:
This is who your puppy will be registered to (AKC & Microchip).  Include First and Last names(s).
Address:
Phone Number:
Best phone number to reach you at if your puppy was to get lost.
Official AKC Name of Puppy:
If you are not sure yet, please be thinking of a name and let us know.
Thank you for taking the time to complete this, it is important as it will be with your puppy forever.
Questionnaire:
Are you familiar with the Shiba Inu Breed?  Please describe:
Do you have a fenced in yard?  If not, please explain your exercise plans for your puppy:
Are there any children in the household?  Are they good with dogs?
Do you plan on having your puppy spayed or neutered?
Do you plan on taking your puppy to an obedience class?
Purchasing a puppy is a long-term commitment.  If your circumstances should change, and you are no longer able to care for your puppy, what is your plan?
If you would like more information on the Shiba Inu, please click here:
First, click "Submit" to complete puppy application, after you have submitted application, return to the home page to submit payment.
YesNo
YesNo
AgreeDisagree
YesN/A
Same As Listed Above
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