12 Hills Dog Rescue Adoption Fee Deposit
12 Hills Dog Rescue Adoption Fee Deposit
$
0
Total
Office Use Only
Date deposit is paid:
_____________________________
Pet Deposit is for:
__________________________
Sex:
__________
Age:
___________
S/N:
___________
Color and description:
____________________________________
Dog you are interested in adopting?
*
Name of Potential Adopter:
*
Address
Address
*
Street Address
Address Line 2
City
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province / Region
Postal / Zip Code
United States
Country
Phone
Phone
*
-
###
-
###
####
Email
*
AS THE POTENTIAL ADOPTING PARTY I AGREE TO THE FOLLOWING:
The adoption deposit fee of $50.00 is non-refundable, except under the following circumstances:
1)
If I/We back out of the adoption the deposit fee is forfeited and will not be refunded.
2)
If I/We are not approved for adoption
half of the fee will be refunded
.
3)
If I/We are accepted to adopt the dog the $50.00 deposit fee will become part of the total adoption amount.
ADOPTER (print/type your name):
*
Date
Date
*
/
MM
/
DD
YYYY
Your Signature:
By signing here I agree to this legal and binding contract and will abide by its terms.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Spam Protection. Please answer this simple question.
What is the sum of 2 and 4 ?