Burmack Puppy Application

This application form is provided for those who would like to find out more about obtaining a Toy Manchester Terrier. We may not have a litter or dog available at this time, but may know of other reputable breeders with puppies or dogs available. This form gives us insight into your needs and expectations and is a necessary part of our screening process. Upon submission of this form, we will reply as quickly as possible.

* Fields marked with an * are required to be completed.

Please provide the following Contact Information:

*Name

Street Address

Address (cont.)

*City

*State/Province

Zip/Postal Code

Country

*E-mail
Do you have Children?

Yes No
What are your Children's Ages?

Age
Have you ever owned a Dog before?

Yes No
* Do you have a fenced in yard for a Dog's use?
* Are you looking for a Toy or Standard Manchester Terrier?
* Are you looking for a Male or Female?

* Please select those age groups that are acceptable for your puppy or dog.

2-3 months old 4-5 months old  6 - 12 months old

Young Adult 1 - 4 years of Age   Older Dog 5 years or older

* Are you looking for a Family Pet or a Show Potential Dog?
* Where will the dog's living accommodations be?

If you have selected "Other", describe what living accommodations the dog would have.

Describe "Other" :
When did you plan to add a Manchester Terrier to your home?

As Soon As Possible
1 - 2 Months
3 - 6 Months
12 - 18 months
Do you belong to any Dog-Related Clubs?

Yes No
If you answered "Yes" above, please provide list those Clubs here.
* Why have you decided the Manchester Terrier is the right breed for you?
* Please tell us about yourself?

*Name
Street Address
Address (cont.)
*City
*State/Province
Zip/Postal Code
Country
*E-mail

Burmack Puppy Application

Copyright © 2002 Burmack Manchester Terriers. All rights reserved. Revised: 10/29/06

Copyright © 2002 Burmack Manchester Terriers. All rights reserved.
Revised: 10/29/06