Deposit Form

Dom & Norene Szechenyi
31119 59th Ave NW
Stanwood, Wa 98292
Phone: (360) 629-7504
Email: nordomsze@msn.com

PUPPY DEPOSIT AGREEMENT

This deposit is made for a puppy from the litter described below:

Sire: HRCH CH INTL CH* Nordom's Apache Rebel MH WDQ
Dam: CK'S Mo Money SH WDX

DATE OF BIRTH (OR APPROX.DUE DATE if Applicable): November, 14 2008.
This deposit is for a (Male) - (Female) CIRCLE ONE.

Purchase Price:___________Deposit Amount: $200.00 PRIOR TO WHELPING.
I understand that once Litter is whelped an additional amount is due to equal 1/2
the total purchase price of pup.

I understand that the balance of puppy price is due at the time I pick up the Pup or
Prior to shipping of the pup, should that be required.

Pup will be able to be picked up and/or shipped no sooner than 7 weeks of age and
on the day & date set forth by breeder.

The puppy deposit is NON-REFUNDABLE, except under the following conditions:
~Nordom Chesapeakes does not have a puppy for the prospective buyer(s) because
of death, injury or illness of puppy.
~If unable to provide a puppy, Nordom Chesapeakes will apply the deposit to the next
available litter, or refund the entire deposit, as per the prospective puppy buyer(s).

NOTE: We, Dom & Norene Szechenyi (Nordom Chesapeakes) reserve the right to
refuse to sell puppies to individuals if it is deemed the prospective buyer(s) or the home
is not appropriate, even if a deposit has been made. In this case the puppy deposit will
be refunded.

I have read and understand the above. I agree to abide by the rules of this agreement.

Puppy Buyer(s) printed name:_____________________________________________

Address: (printed)_______________________________________________________

Email address:________________________Phone Number:____________________

Purchaser's signature:____________________________________Date:___________