East Coast Parti Yorkies

Deposit Form for litter

                                                                                                            Date: _________

              First Choice

Mom: __________________________     Dad: ____________________________

Sex:   M    F                Size:    Smaller - (0 – 4.5 lbs)              Larger - (5 – 7.5 lbs)

Second Choice

Mom: __________________________    Dad: _____________________________

Sex:   M    F           Size:    Smaller - (0 – 4.5 lbs)          Larger - (5 – 7.5 lbs)

Deposit amount: ______________ Total amout of puppy:______________________

Breeder  or   Pet

(Please print all information below)

Name to appear on web site:____________________________________________

Full contact name:___________________________________________________

Phone number with area code: __________________________________________

Full Address: _______________________________________________________

                     _______________________________________________________

Full Deposit will be refunded Only if there is not a sex in the litter that you have chosen above. Please sign below and mail with your $500.00 deposit. Deposit will be deducted from the total price of the puppy. (POST OFFICE MONEY ORDERS ONLY - NO EXCEPTIONS. If I do not receive Post Office Money Order for the deposit, will be returned.) Two sets of pictures will be taken before the puppy is ready to leave the breeders home. Breeder always has first choice to keep back out of the litter. The breeder has a right to pick and choose who our little treasures go home with.  You must be 18 years of age or older to place a order, Thank you

Mailing Address:

Laurie Cusimano

1614 Starr Road

Centreville, Maryland 21617

_____________________________________________

Customer Signature                                         Date

If Shipping Puppy please fill out information below:                                     

_____________________________________________________________________

                                                                                  2

Please print

Full name: _____________________________________________________

Full Address: ___________________________________________________

                      __________________________________________________

Name of Airport: ________________________________________________

Airport Address: ________________________________________________

Home Phone with area code: _______________________________________

Cell Phone with area code: ________________________________________