Name
E-mail
Tel
Fax
Address
Address
City, State, Zip

Are there children in the home?  -- No Yes   If Yes, list ages:

Is someone home most of the time?  -- No Yes

Are there other pets in your home? -- No Yes If Yes, type(s) of pet:

Is your yard fenced in? -- No Yes   If not, are you willing to fence in?  -- No Yes

What is your intended purpose of owning one of our terriers?

Please Select Companion/Pet Hunting Agility/Obedience/Flyball Buddy Conformation Ring Breeding Program Other, see Description Other:

In which terrier are you interested?   Please Select Parson Russell Terrier (Long Legged) Russell Terrier (Short-Legged)

In which age group of terrier are you interested?   Please Select Young Pup (8 wks - 4 mos) Older Pup (5 mos. - 18 mos.) Retiring Adult

Do you understand what a "Limited Registration" involves?

Please Select No, please send me more information. Yes, I understand that I should neuter my terrier as soon as my veternarian feels it is safe to do so.

Do you agree to take your terrier to dog school and acquire a Canine Good Citizen Certificate?

Please select Yes and I will mail Mitern Farm a copy in order to receive a $25 Rebate No, not interested

Terms & Conditions: Mitern Farm microchips all terriers who pass through our hands. This applies to our own, home grown terriers or a rescue dog. We never want one of our MITERN dogs to be in a shelter and/or rescue program. We are responsible for our terriers; we placed them on this earth. You also accept responsibility for their nurturing and well being when you purchase one.  When a puppy becomes available that fits what you want, we will either call and/or send you a postcard. At that time, if you are still interested, we require a $100 non-refundable deposit. (WE ACCEPT CREDIT CARDS). If you are no longer interested, we ask that you send us an email or written note to that effect.  All terriers that are sold by Mitern Farm leave with a full written contract that must be signed by both parties. We fully guarantee our Terriers in writing. We ship from Logan International Airport, Boston, Massachusetts.

Acknowledgement: Please select Yes, I agree to the Terms and Conditions No, I do not agree with the Terms and Conditions  

Purchase Policy: View Policy Please select Yes, I have read the Purchase Policy No, I did not read the Purchase Policy  

Additional Comments?

   Fill in/Select Answers. Click Here to Print for Mailing or to Make a Copy

Submit this Form now by pressing "Submit Application" above or print it and mail the completed form to:

Mitern Farm, Applications, P.O. Box 550, Raynham Center, MA 02768  Tel. 508-824-1490