Name:

Address:

City, State Zip

Phone:

E-mail:

I understand that the deposit ($100 or $200 for pick of litter) I am submitting is to reserve a puppy from the above planned litter and that the amount I am submitting will be applied to the purchase price of my ACD puppy. I understand that a deposit constitutes an intent to purchase a puppy, but not an insurance that there will be a pup available for me from this litter. I understand that full refund of my deposit will be made under the following circumstances:

In the event that there is not a suitable puppy in the planned litter to meet needs specified in application (in this case, deposit can be refunded or carried over to next planned litter).
I understand that the breeder will be accepting a maximum of four "show/breeding quality" deposits and four "pet quality" deposits for this litter and that my position on the waiting list depends on: date of initial contact of the breeder along with date of questionnaire/deposit return to breeder.

Signed: _________________________ Date: ___________