Purchased This Date of: ________________________________________________

Dog/Type: ___________________________________________________________

Name if any:__________________________________________________________

Purchased " AS IS" From: _______________________________________________

Address: _____________________________________________________________

____________________________________________________________________

Buyer's Name: ________________________________________________________

Address: _____________________________________________________________

_____________________________________________________________________

Purchase Price: $_________________________

Cash ( ) _________________________________

Check ( ) Amount________________________Number________________________

Driver's License No._________________________Licensing State_______________

Signature of Seller______________________________________________________

Signature of Buyer______________________________________________________