Bliss Acres Farm

Nickname of the puppy your interested in:

Breed of the Puppy:

Male or Female Puppy:

Long or Short Hair Puppy:

Your Name:

Street Address or P.O. Box:

City, State, Zip Code:

Home Phone:

Cell Phone:

Work Phone:

Email Address:

Closest Major Airport:

2nd Closest Major Airport:

How soon would you like to find and purchase a new puppy:

How did you find us or hear about us:

Preferred method of payment (if purchasing):

Did you read our shipping & health page?

Did you read our payments page?

Did you read our puppy care page?

Do you have any other pets (if so, what kind):

Have you read the information on our website about Hypoglycemia?

Will this be your first pet or first puppy?

Do you have a vet selected that specializes in small toy breed dogs?

Do you rent or own your home?

If renting, do you have permission from your landlord to have a puppy in the home?

About how many hours are you away from the home each day?

Who will care for your new puppy while your away?

Are you ready to place a deposit on one of our puppies?

Will you need shipping arrangements?

Which days of the week are you NOT available to receive you puppy at the airport?

Are there any hours of the day that you are NOT available to receive your puppy at the airport?