* Required fields
Name *
E-mail Address *
Telephone# *
Address *
City? *
State/Province? *
Country? *
Do you live in a? *
House
Townhouse
Condo
Do you Own, Rent or Live with Parents?
Own
Rent
Live with Parents
If you Rent, does your lease allow you to have Pets?
Yes
No
Do you have a Fenced Yard or Enclosed Balcony?
Fenced Yard
Enclosed Balcony
None
Are you looking for a Bengal or a Portuguese Water Dog *
Bengal
Portuguese Water Dog
Are you looking for a Pet/Breeder/Show *
Pet
Breeder
Show Quality
Foster Parent Program? Please Tell Us Why You Would Qualify.
Are you interested in doing any of the following? *
Conformation
Agility
Obedience
Water Work
None of the Above
Do you understand that a puppy/kitten sold as a Pet will be sold on a Non-Breeding Contract? *
Yes
No
Do you have a preference for Male or Female?
Male
Female
What Colour Bengal are you looking for?
Rosetted Brown Spotted Tabby
Brown Marble
None
What colour Portie are you looking for?
Black
Black & White
Brown
Brown & White
Irish Marked
Parti-Coloured
No Preference
How did you hear about us?
Tell Us About Your Household
What age are the Children in the Household? *
0-5
5-10
10-15
15-20
Older
Number of Pets in the Household? *
0
1
2
3
4
5
5+
Why do you feel a Bengal/Portuguese Water Dog is a good choice for your Household? How much research have you done on the particular breed of dog/cat? *
