Excelsior’s Havanese Puppies
Winston, Oregon

Thank you for your interest in adopting one of Excelsior’s Havanese Puppies.
In order for me to get to know something about you,
Please Fill out the Application Below.

1.

2. Address:

3.

4.

Living Environment

5. Please describe your family dynamics (ages of children, at home, etc.).
Family dynamics:

Why do you want a Havanese Puppy?

6. Why are you interested in a Havanese puppy and what research have you done on this breed?
Why a Havanese/Research:

7. Are you wanting a pet  a show dog   to Breed?  (Check all that apply)

8. Are you interested in conformation, agility, obedience, therapy dog, other (please explain)
Interests?

9. Are you willing to do health testing? Yes  No

10. Are you willing to sign a spay/neuter agreement?  Yes   No

Prior Experience

11. Have you ever owned a dog?  Yes   No

12. Purebred? Yes  No

13. If so,

Other Information

14. Name and address of your vet?
Veterinarian:

15. Is there anything else you would like us to know or you would like to add?
Comments:/Sex Desired/ How did you happen on our site?

A Written Contract comes with all our puppies.
I will be happy to e-mail you a copy upon request.

Thank you for your interest in adopting one of Excelsior’s Havanese Puppies,
I will be in touch with you as soon as I have had a
chance to review your  application.