1. Name    
   Address 
   City          State    Zip    
   Phone       email 
2. Date Form Being Submitted     
3. Have you ever owned an ACD before?

           - No Yes, non-registered Yes, registered

1. What would you like to do with your ACD?

            Companion                     Obedience (competitive)

            Herding (competitive)      Agility

            Herding (ranch help)        Breeding

            Conformation Shows       Couch Potato

1. Do you have a color/marking preference?
   - No preference Blue (no marking perference) Blue (prefer face markings) Red (no marking preference) Red (prefer face markings) Other:
   
2. Do you have sex preference?
   - Either Prefer Male Prefer Female Must have male Must have female
   
3. Where will your ACD live??
   - Primarily Inside Inside & Outside Primarily Outside Always Outside
   
4. Please enter a brief description of your hobbies:
5. 
   
   
6. If you have contacted other breeders, please list:
   
   
7. Please provide us two references we could contract:

   Name:    
   Phone:   
   E-mail:   

   Name:    
   Phone:   
   E-mail:   

   Thank you for taking the time to fill out this application.