Puppy hold request for Teacup And Toy Pets Boutique 2008
Full Name: *
Maiden Name:
Street Address:
Box or Apartment Number #
City: *
Zip Code:
State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *
Co-Applicant Information
First Name:
Last Name:
Contact Information
Home Phone:
Cell Phone:
Work Phone:
Prefer to be contacted at this number:
E-Mail Contact Information
Primary E-Mail Address: *
Home E-Mail Address
Work E-Mail Address::
Spouse E-Mail Address::
Puppy Information
Puppy Number: *
Breed: Malti Poo Maltese Chihuahua Chihuahua Terrier Jack Russell Terrier Mix Poodle Shih Tzu Shih Tzu Maltese Daisy Pomeranian Chi-Weenie Peek A Poo Long / Medium Coat Chihuahua Yorkie Morkie Pekingnese Havanese Not Sure of Breed ShihTzu Maltese
Add breed if not listed:
Sex: Male Female
SIZE: Tiny Teacup Teacup Tiny Toy Toy Select Tiny Teacup Specialty Pet Celebrity Pet
Purchase Price:
Coupon Code:
Amount of discount coupon:
Referral Credits:
Waiting List Deposit:
Total Amount Due:
Hold Request Options
I, am requesting a 12 hour hold at no charge
I, am requesting a 24 hour hold (Charge $25.00)
I, am requesting a 48 hour hold (Charge $50.00)
I, understand pet may not be held without paid holding fee, if a Puppy Purchase Application is submitted for the pet in question by another applicant.
If I, decide to pass please apply my payment toward waiting list for future puppy.
I, understand holding fee is not refundable, but can be used toward future purchase.
If you will come in person, enter estimated time you will come to the pet boutique.
Please hold puppy until this date:
Date selected will be what day of the week?:
Estimated time you will come to our location?:
I, understand I must submit a waiting list application if I, want to be added to the waiting list for a future puppy.
Name on Credit Card:
Method of Payment ( Select Credit Card ): Visa Credit Card Master Card American Express
Credit Card Number:
Expiration Date:
Security Code:
Are you a previous Customer?:
Referred by:
How did you hear about us?:
How many Puppies purchase from Teacup And Toy Pets Boutique:
Question # 1:
Question # 2:
Question # 3:
Hobby:
Occupation: 
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