Listing to Place Form

Name: 
Email address: (e.g.: you@aol.com) 

Phone number (please include area code): 

Address:


City/Town:State/Prov.: Post./Zip Code: 
Breed: 
Sex: MaleFemale
Color: BlackWheaton Brindle Gray Grizzled Sandy
Age: 
Altered: No Yes
Children At Home: No Yes    Ages: 
Dogs Registered Name: 
Dogs Call Name:     AKC# 
Microchip#:     Tattoo: 
Breeder: 
Breeder Address:


City/Town: State/Prov.: Post./Zip Code: 
Check All that Apply:
Housetrained  Digger  Barker  Chewer  Dog Aggressive  Escape Artist 
Behavior with other dogs:

Behavior with other animals:

Veterinarian: 
Shots: Up to DateNot up to date
Is this dog on Heartworm prevention:Yes No
What is the reason you are placing this Scottie?

Date dog must be out of current home: 
Please briefly describe the disposition of this dog:

Please list any other comment that you feel would aid us in placing this dog:

How did you hear about us?

By choosing the "Send it" button you are acknowledging that all of the above information is true and correct to the best of your knowledge.