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Order Form
Last updated 14/01/2009
Information Required
Full Name:
Residential Address:
E-Mail Address:
Phone number
Home:
Work:
Cell:
State name of Puppy/Adult on Numinous Website you are interested in:
Are you interested in a male or female puppy?
(select)
Male
Female
Either
Will you consider an older dog instead of a puppy?
(select)
Yes
No
Are you interested in a Long Coat or Smooth Coat?
(select)
Long Coat
Smooth Coat
How did you hear about Numinous?
Why do you want to buy a Chihuahua?
Where will the dog be kept during the night?
Where will the dog be kept during the day?
Is anyone home during the day?
(select)
Yes
No
Do you have any other animals?
(select)
Yes
No
If Yes what?
Do you have any children?
(select)
Yes
No
If yes, what are their ages
Are you interested in a pet or a show dog?
(select)
Pet
show dog
Do you intend to breed dogs?
(select)
Yes
No
How will you be getting the dog? Shipping, picking up?
(select)
Shipping
picking up
Do you want Numinous to arange Transport (Shipment)?
(select)
Yes
No
Would you like to be put on our Mailing list?
(select)
Yes
No
Any other requirements?
Please Note: We are situated in Western Cape, South Peninsula, Fish Hoek.
Copyright Numinous Chihuahuas 2009. All Rights Reserved.
Created by
SilverSites