Please print this form, fill out completely and don't forget to sign, date and include this form
along with your deposit for $200.00.
Made payable to: Sharon LaRose
Name_________________________________________________
First M Last
Address_______________________________________________
City ______________________ St__________ Zip____________
Home Phone: ________________________
Work Phone:_________________________ Ext:____________
Cellular:____________________________
Email address:_________________________
Please let me know the following
SIZE: Tiny Tea Cup / Imperial / Standard / Any
SEX: Male / Female / Any
COLOR:
This deposit of $200 places me on the waiting list of Wishwell Kennels for the next
available puppy. I understand that requests will be filled on a first come first serve basis
and that I will have one year from the signing of this contract to find my Shih Tzu puppy.
This deposit is non-fundable if I should change my mind.
I have read this form, understand it, and agree to the terms therein.
Signature_______________________ Date___________________
SEND TO: Sharon LaRose
Wishwell Kennels805 Cottonwood Place Liberty, MO 64068