Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sex

Male

Female

Color/Coat

Blue

Silver

Longhair

Shorthair

Are you interested in a started puppy or older dog?

8-12 weeks

12-16 weeks

4-6+ months

1 yr

Previous Weim Owner

Yes

No