W
First Name
 Last Name
Phone Number
Mailing Address
City
 Province/State
Zip/Postal Code
Email Address
Today's Date:
1st Choice Color
 2nd Choice Color
Click this box if you are only interested in one color:
Sex Preference
Click this box if you are willing to consider the opposite sex should none
(or few) of your preference be born:
Are you requesting a puppy from a specific litter? If yes, please indicate the sire and dam's names:
No
Please indicate why you are interested in an Eromit Lab puppy:  (select as many as you like)
Hunting
 Family Pet
 Search & Rescue
Field Trials
 Obedience
 Detection
Hunt Tests
 Tracking
 Service Dog
Agility
 Breeding
How did you hear about us?
If you do not live in the immediate area, how do you plan to get your puppy home? (drive to pick up,
ship by airplane, etc).
I am interested in acquiring a puppy with full registration for competition or breeding purposes.
Yes
 No
Use this area to let us know about any special characteristics you are looking for in a puppy, or to tell us
more about yourself. If you have any questions, include them here and we will be happy to answer them
for you.
Eromit Labrador Retrievers
Puppy Reservation Request
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To reserve a puppy, or to be placed on our waiting list, please submit this electronic reservation request.
We will contact you once your request is received - a $200 deposit is required once the breeding is
confirmed in order to reserve a puppy. (No deposit is required to be placed on our waiting list). Puppies will
be selected in the order of deposits received, according to the color, sex and personality preferences  you
have submitted.