Name:  
Street Address:  
City, State & Zip:  
Phone Number:  
Email Address:
Have you personally owned a Scottie before? Yes  No  If Yes, for how long
Do you currently have any pets?  Yes  No  If Yes, what age do you want
Do you plan to show this dog? Yes  No
Do you plan to breed this dog?  Yes    No
Must the dog be a specific age?  Yes   No   If yes, what specifics? Puppy 3 to 6 month Puppy 6 to 12 month Adult
Must the dog be a specific color?  Yes  No  If yes, what color? Wheaten Black Brindle
Must the dog be a specific sex?  Yes   No  If yes, Male or Female? Male Female
Please check the appropriate box:  Own House  Rent Home  Live in Apt/Condo
   - If you live in an apartment/condo, does your lease allow pets? Yes  No
Do you have a fenced yard?     Yes  No  If yes, what type of fence:
Do you have a pool?   Yes  No
Number of Adults in home:    
Number of Children in home:  Ages of Children:
Will the dog have regular contact with children?  Yes  No
Is someone home during the day?  Yes  No   If not, how many hours a day will the dog be left alone:
Where will the dog stay while alone?
Where will the dog sleep at night? 

Comments:

You will receive contact information for breeders who may be able to help you in your search for a Scottie. If you do not receive a response to your email to a breeder to whom you have been referred within a two week period please contact Breeder Referral.