{"id":17,"date":"2015-02-08T12:04:15","date_gmt":"2015-02-08T17:04:15","guid":{"rendered":"http:\/\/destinybichons.mandbwebdesign.com\/?page_id=17"},"modified":"2022-08-11T11:49:54","modified_gmt":"2022-08-11T15:49:54","slug":"puppy-application","status":"publish","type":"page","link":"https:\/\/www.destinybichons.com\/index.php\/puppy-application\/","title":{"rendered":"Puppy Application"},"content":{"rendered":"\n\n<!-- Fast Secure Contact Form plugin 4.0.52 - begin - FastSecureContactForm.com -->\r\n<div style=\"clear:both;\"><\/div>\n<p>If you are serious about buying a puppy, please fill out the following application and I will contact you as soon as possible. If you need immediate attention, you can contact me at 770-926-6258.  Thank you for your interest.<\/p>\r\n<div id=\"FSContact1\" style=\"width:99%; max-width:720px;\">\r\n<form action=\"https:\/\/www.destinybichons.com\/index.php\/wp-json\/wp\/v2\/pages\/17#FSContact1\" id=\"fscf_form1\" method=\"post\">\r\n<fieldset id=\"fscf_form_fieldset1\" style=\"border:1px solid black; width:99%; max-width:720px; padding:10px;\">\n<legend>Puppy Application<\/legend>\n\n<div id=\"fscf_required1\">\n  <span style=\"text-align:left;\">*<\/span> <span style=\"text-align:left;\">indicates required field<\/span>\n<\/div>\n\n\n<div id=\"fscf_div_clear1_0\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_0\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\r\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_name1\">Name:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\r\n    <div style=\"text-align:left;\">\r\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_name1\" name=\"full_name\" value=\"\"  \/>\r\n    <\/div>\r\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_1\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_1\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_email1\">Email:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_email1\" name=\"email\" value=\"\"  \/>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_1_2\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_1_2\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n    <div style=\"text-align:left; padding-top:5px;\">\n      <label style=\"text-align:left;\" for=\"fscf_email1_2\">Re-enter Email:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_email1_2\" name=\"email2\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_16\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_16\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_16\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_16\">Phone Number:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_16\" name=\"Phone-Number\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_4\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_4\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_4\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_4\">Address:<span style=\"text-align:left;\">*<\/span><\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px; height:80px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_4\" name=\"Address\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_5\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_5\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_5\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_5\">Where do you work?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_5\" name=\"where-do-you-work\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_7\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_7\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_7\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_7\">Do you travel for your work? If so, for how long at a time?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px; height:80px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_7\" name=\"travel-for-your-work\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_8\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_8\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_8\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_8\">Marital Status:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_8\" name=\"marital-status\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_9\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_9\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_9\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_9\">Spouse&#039;s Name:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_9\" name=\"spouse-name\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_10\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_10\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_10\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_10\">Where does your spouse work?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_10\" name=\"spouse-workplace\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_11\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_11\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_11\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_11\">Number of children living at home:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_11\" name=\"If-yes-was-it-a-Bichon[]\">\n        <option value=\"1\">Please select<\/option>\n        <option value=\"2\">1<\/option>\n        <option value=\"3\">2<\/option>\n        <option value=\"4\">3<\/option>\n        <option value=\"5\">4<\/option>\n        <option value=\"6\">5<\/option>\n        <option value=\"7\">6<\/option>\n        <option value=\"8\">7<\/option>\n        <option value=\"9\">8<\/option>\n        <option value=\"10\">9<\/option>\n        <option value=\"11\">10<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_13\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_13\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n    <div  id=\"fscf_label1_13\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_13\">Name, Gender and Ages of Children:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px; height:80px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_13\" name=\"name-gender-ages-of-children\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_12\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_12\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_12\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_12\">Type of House:<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <input style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" type=\"text\" id=\"fscf_field1_12\" name=\"type-of-house\" value=\"\"  \/>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_14\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_14\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_14\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_14\">Do you have HOA or deed restrictions on pets?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_14\" name=\"hoa-deed-restrictions[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_15\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_15\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_15\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_15\">Do you have a fenced-in yard?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_15\" name=\"Do-you-have-a-5-x-10-foot-area-you-can-f[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_17\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_17\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_17\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_17\">Do you have a swimming pool?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_17\" name=\"Do-you-have-a-swimming-pool[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_18\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_18\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_18\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_18\">Do you have any other pets in the house? If so, please list the type and breed.<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px; height:80px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_18\" name=\"Do-you-have-any-other-pets-in-the-house\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_19\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_19\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_19\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_19\">Which gender would you prefer?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_19\" name=\"Which-gender-would-you-prefer[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Male<\/option>\n        <option value=\"3\">Female<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_20\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_20\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_20\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_20\">Would you consider the opposite gender?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_20\" name=\"Would-you-consider-the-opposite-gender[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_21\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_21\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_21\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_21\">If you previously owned a dog before, what kind was it and how long did you have it?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <textarea style=\"text-align:left; margin:0; width:99%; max-width:500px;padding:2px; height:80px;background-color:#99b2b2;font-size:18px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_21\" name=\"If-you-previously-owned-a-dog-before-wha\" cols=\"30\" rows=\"10\" ><\/textarea>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_22\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_22\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_22\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_22\">Do you have the time and are you willing to do the amount of brushing and combing required to keep your new pet clean and free of mats?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_22\" name=\"Do-you-have-the-time-and-are-you-willing[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_23\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_23\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_23\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_23\">Are you willing to spend the time and money required to care for your pet properly?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_23\" name=\"Are-you-willing-to-spend-the-time-and-mo[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_24\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_24\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_24\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_24\">Are you willing to purchase a crate and use it until your puppy is housebroken?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_24\" name=\"Are-you-willing-to-purchase-a-crate-and[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_25\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_25\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_25\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_25\">Are you willing to Puppy-Proof your house and your yard?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_25\" name=\"Are-you-willing-to-Puppy-Proof-your-hous[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_26\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_26\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_26\" style=\"text-align:left; padding-top:5px;\">\r\n      <label style=\"text-align:left;\" for=\"fscf_field1_26\">If purchased as a pet, do you agree to have your Bichon puppy spayed\/neutered?<\/label>\n    <\/div>\n    <div style=\"text-align:left;\">\n      <select style=\"text-align:left;background-color:#99b2b2;font-size:18px;padding:2px;height:32px;color:#663333;border-left:solid #000000 2px; border-top:solid #000000 2px; border-bottom: solid #666666 4px; border-right: solid #666666 4px;\" id=\"fscf_field1_26\" name=\"If-purchased-as-a-pet-do-you-agree-to-ha[]\">\n        <option value=\"1\">Please Select<\/option>\n        <option value=\"2\">Yes<\/option>\n        <option value=\"3\">No<\/option>\n      <\/select>\n    <\/div>\n\n    <div style=\"clear:both;\"><\/div>\n<\/div>\n\n  <\/div>\n<\/div>\n\n<div id=\"fscf_div_clear1_27\" style=\"clear:both;\">\n  <div id=\"fscf_div_field1_27\" style=\"clear:left; float:left; width:99%; max-width:720px; margin-right:10px;\">\n\n    <div style=\"clear:both;\"><\/div>\n<div style=\"border-bottom:solid 1px #FFF; padding-bottom:15px;\">\n\n    <div  id=\"fscf_label1_27\" 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