Street: ___________________________________________________

City: _______________________ State: ____ Zip Code: ___________

Phone: ( ) _____-________ Cell Phone: ( ) _____-________

E-mail Address: ________________________________ Nearest MAJOR Airport ____________________

Please complete the following questionnaire to help select the ideal Australian Labradoodle addition to your family. Our waiting list is developed in the order of receipt of applications and accompanying a non-refundable $300.00 deposit, which is applied to the purchase of an Australian Labradoodle. Our puppies are $2500.00 and must be paid in full prior to being de-sexed to go to their new homes.

1) Gender preferred: Male ___ Female ___ Either ___

2) Color: (Number in order of color Preference – 1 thru 5) Mark "0" to exclude any color.

Black _____ Chocolate _____ Red/Apricot _____ White _____ Cream _____

3) Coat Preference: Fleece: Curly ___ Wavy ___ Doesn't Matter_________

4) What size do you prefer?     Miniature(15-18 lbs)________    Small Medium (18-25 lbs)____________

5) Preferred date for receiving your Australian Labradoodle: _______________________________________

6) Do you or your family members have dog related allergies or asthma? Yes ___ No ___

7) Does your household have children? ________ if so, age (s) and name (s): ____________________________

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8) Will your puppy be: Living inside the home? _____ Kept in a Kennel? _____

9) Is your family’s lifestyle: Active ___ Somewhat Active ___ Sedentary ___

10) Are any family members physically impaired? _____ If so, will puppy be trained for service? _____

Signature: _________________________________ Date: ______________

　Please send your payment by certified check or money order payable to:

Paula Willand (PRLabradoodles)

707 E. Kelly Rd

Bellingham, WA 98226

Website: www.PRLabradoodles.com email: paula@PRLabradoodles.com