Perspective Pet Parent(s) Information
Last name(s):
Co-Parent Last Name
First name(s):
Co-Parent First Name
Address   NO PO BOXES Please
City
State
Zip Code
E-Mail Address:
Primary Phone:
Is this number a Land Line?
or a Cell Phone?
Is this number a Land Line?
or a Cell Phone?
Secondary Phone:
Own
We may need a copy of your mortgage statement or tax bill
Housing, Do You
We need a letter from the landlord or a copy of your lease stating that pets are allowed
Rent
How did you hear about us?
FaceBook
Web Site
Friend
Other
If NO, please tell us how many you have/had and their age and sex
Yes
Will this be your first Chihuahua?
No
Do you own any other animals, other than Chihuahuas?
Yes
No
If Yes, Please tell us how many, what  breed, and their ages
Have you researched the breed?
Yes
No
Do you currently have a Veterinarian?
Yes
No
If Yes, the Veterinarian's Name
Phone #
Have you ever been charged with Cruelty to Animals?
Yes
No
Have you ever surrendered a pet to an animal shelter?
Yes
No
If yes, do you care to explain the circumstances for the surrender?
How many hours a day will
the puppy be left alone?
How many hours a
day will the puppy
be crated?
How many humans live in the home?
Childrens age groups if any
Is everyone in the home in
agreement with getting a new puppy
Yes
No
Press Ctrl and click if multiple groups
Do you have a specific puppy in mind?
Yes
If yes, Which puppy?
No
Do you have a preference as to the sex of the puppy?
Male
Female
No Preferance
Do you have a color Preference?
No any color
I prefer
We breed both AKC and CKC Pure Breed
Chihuahua's, Do you have a preference?
AKC
CKC
No Preference
Do you plan on breeding this Chihuahua?
Yes
No
Yes
If no, are you willing to sign
a spay / neuter contract?
If Yes, please explain so we know more about you such as?
No
to keep the puppies yourself or to give to family and friends
Are you breeding:
as a Licensed or Hobby Breeder to sell the puppies
Yes
No
If Selling, do you have a website?
If yes, please list your URL:
Are you state licensed
Breeder?
If yes, State and
License Number
Yes
No
This application is just that, an application. It does not constitute a sale or hold of a puppy. No
puppy will be placed on hold until this application is approved by the breeders Becky and Don
D’Allaird. The placement of our puppies is the most important part of our business. Our goal is
to ensure that each of our families are completely educated on the commitment and
responsibility that a new Chihuahua puppy requires and have the resources required to care
for a new puppy. I / We understand that by signing this application it does not guarantee me
the purchase of a puppy or to be placed on a waiting list. I / We also understand that the
breeders Becky and Don D’Allaird have the final say as to whether to approve or deny the
application. The breeders Becky and Don D’Allaird will notify you within 96 hours of receiving
this application as to its approval status. Please type your name (s) below
Full Name
Full Name
By submitting this form you agree that you answered all the questions truthfully
to the best of your knowledge.  Any false information entered can cause this
form to be void and any deposit placed on a puppy to be forfeited.
Bella's Little Angels
Your Chihuahua Breeders
Copyrighted 2007 - 2017 Bella's Little Angels
All Rights Reserved
NYS & AKC Inspected
Puppy Application
All puppies are sold with a LIMITED Registration unless approval is granted by
Bella's Little Angels prior to the sale.
Keeping your personal information private is our utmost concern.  We will never sell, or
share any of your information and will be stored on our secured offline server.   If we do
not have a puppy of your likings, with your permission we will forward your name,
phone number and / or e-mail address to other breeders who may have a puppy of your
liking.  Also if you do purchase a puppy we will forward your information to AKC or CKC  
for registration purposes.  
You may request that we do not provide your information to AKC or CKC.    Thank you
All puppies are sold with a LIMITED Registration unless approval is granted
by Bella's Little Angels prior to the sale.