Name*:

Address:

City: State: Zip:

Phone*: Email*:

How did you hear of us?

Your answers to the following questions will help us to match you with the perfect puppy for you.

Sex: male female no preference

Coat Type: smooth coat plush coat no preference

companion puppy show puppy working temperament

How many people reside in your household?

How many children? and what are their ages?

Have you owned a dog before? yes no

Tell us what you are looking for in a puppy:

Veterinarian Reference: (please be sure to contact your vet and let them know we will be calling)*

Thank you for considering a JnL Pocono Shilohs puppy. Our hope is to establish a friendship with all of our puppy buyers for the life of their dogs and after.