EmailMe Form - Application for a Gipfel German Shepherd Dog

First and Last Name *

Full Mailing Address *

Email *

Home Phone *

Mobile

Colour/Coat Preference *

Black/Tan

Sable

Long Coat

No Preference

How would you prefer to pay? *

One amount prior to pickup

Two amounts prior to pickup

Personal Cheque

Direct Bank Deposit

Gender Preference *

Have you owned this breed before? *

Do you agree with desexing? *

Please indicate all that apply.

Please provide 2 Non-Family References that are willing to be contacted. Please include phone number and/or email contact *