<% ' FP_ASP ASP Automatically generated by a Frontpage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("puppy_application1_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "Results", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(32) Dim arFormDBFields0(32) Dim arFormValues0(32) arFormFields0(0) = "Evephone" arFormDBFields0(0) = "Evephone" arFormValues0(0) = Request("Evephone") arFormFields0(1) = "vetsname" arFormDBFields0(1) = "vetsname" arFormValues0(1) = Request("vetsname") arFormFields0(2) = "dayphone" arFormDBFields0(2) = "dayphone" arFormValues0(2) = Request("dayphone") arFormFields0(3) = "vetreference" arFormDBFields0(3) = "vetreference" arFormValues0(3) = Request("vetreference") arFormFields0(4) = "childrenages" arFormDBFields0(4) = "childrenages" arFormValues0(4) = Request("childrenages") arFormFields0(5) = "dogsspayneuter" arFormDBFields0(5) = "dogsspayneuter" arFormValues0(5) = Request("dogsspayneuter") arFormFields0(6) = "numberofcats" arFormDBFields0(6) = "numberofcats" arFormValues0(6) = Request("numberofcats") arFormFields0(7) = "Addy" arFormDBFields0(7) = "Addy" arFormValues0(7) = Request("Addy") arFormFields0(8) = "dogs" arFormDBFields0(8) = "dogs" arFormValues0(8) = Request("dogs") arFormFields0(9) = "pastpets" arFormDBFields0(9) = "pastpets1" arFormValues0(9) = Request("pastpets") arFormFields0(10) = "email" arFormDBFields0(10) = "email" arFormValues0(10) = Request("email") arFormFields0(11) = "fencedyard" arFormDBFields0(11) = "fencedyard" arFormValues0(11) = Request("fencedyard") arFormFields0(12) = "City" arFormDBFields0(12) = "City" arFormValues0(12) = Request("City") arFormFields0(13) = "besttimetoccontact" arFormDBFields0(13) = "besttimetoccontact" arFormValues0(13) = Request("besttimetoccontact") arFormFields0(14) = "numinhousehold" arFormDBFields0(14) = "numinhousehold" arFormValues0(14) = Request("numinhousehold") arFormFields0(15) = "catsspayneutered" arFormDBFields0(15) = "catsspayneutered" arFormValues0(15) = Request("catsspayneutered") arFormFields0(16) = "litter" arFormDBFields0(16) = "litter" arFormValues0(16) = Request("litter") arFormFields0(17) = "puppreference" arFormDBFields0(17) = "puppreference" arFormValues0(17) = Request("puppreference") arFormFields0(18) = "roadrules" arFormDBFields0(18) = "roadrules" arFormValues0(18) = Request("roadrules") arFormFields0(19) = "Name" arFormDBFields0(19) = "Name" arFormValues0(19) = Request("Name") arFormFields0(20) = "ownrenthome" arFormDBFields0(20) = "ownrenthome" arFormValues0(20) = Request("ownrenthome") arFormFields0(21) = "type" arFormDBFields0(21) = "type" arFormValues0(21) = Request("type") arFormFields0(22) = "Zip" arFormDBFields0(22) = "Zip" arFormValues0(22) = Request("Zip") arFormFields0(23) = "Children" arFormDBFields0(23) = "Children" arFormValues0(23) = Request("Children") arFormFields0(24) = "numberofdogs" arFormDBFields0(24) = "numberofdogs" arFormValues0(24) = Request("numberofdogs") arFormFields0(25) = "vet" arFormDBFields0(25) = "vet" arFormValues0(25) = Request("vet") arFormFields0(26) = "cats" arFormDBFields0(26) = "cats" arFormValues0(26) = Request("cats") arFormFields0(27) = "color" arFormDBFields0(27) = "color" arFormValues0(27) = Request("color") arFormFields0(28) = "placement" arFormDBFields0(28) = "placement" arFormValues0(28) = Request("placement") arFormFields0(29) = "State" arFormDBFields0(29) = "State" arFormValues0(29) = Request("State") arFormFields0(30) = "caregiver" arFormDBFields0(30) = "caregiver" arFormValues0(30) = Request("caregiver") arFormFields0(31) = "breedresearch" arFormDBFields0(31) = "breedresearch" arFormValues0(31) = Request("breedresearch") FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 If Request.ServerVariables("REMOTE_HOST") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_HOST"), "Remote_computer_name" End If If Request.ServerVariables("HTTP_USER_AGENT") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("HTTP_USER_AGENT"), "Browser_type" End If FP_SaveFieldToDB fp_rs, Now, "Timestamp" If Request.ServerVariables("REMOTE_USER") <> "" Then FP_SaveFieldToDB fp_rs, Request.ServerVariables("REMOTE_USER"), "User_name" End If fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "puppy_application.htm",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Kelz Pugz

  

Puppy Application

 

You must be approved to purchase a puppy from us. If you are interested in a pup, please provide the information below.

This page is not working please give us a call or email if interested in a puppy. Thank you.

 

Name:

Address:

City: State: Zip Code:

Day Phone: Eve Phone:

Best time to contact you:

Email:

About your family:

How many people in household:

Any children?:

If yes, ages:

Who will be primary puppy caregiver?

Do you own or rent your home:

Is your yard fenced?

Do you have a Veterinarian?

If yes, please provide name:

May we contact your Veterinarian as a reference?

Please note, you may want to contact your Veterinary office after filling out this application if you wish to make them a reference. Due to privacy laws, your Vets office may not be willing to give you a reference without your OK.

Any other animals in household?

Dogs:  Number: Are they spayed/neutered?

Cats: Number: Are they spayed/neutered?

Have you had pets in the past?

If yes, what became of them?

Have you researched the Pug breed?

Your puppy preference would be:

Puppy gender?

Color?

Puppy will be :

Please list which litter you are interested in:

In the event you would have to give up your puppy, even 10 years down the road, what would you do?

I have read and understand your "Road Rules"NO YES

My Road Rules can be found on the information page!!!

Thank you! You will hear from us soon!

Please review our sales.

If you have any questions, please email

or give us a call

(716) 695-3694

 

� Copyright Pets Place Designz 2008

Copyright � 2008 by Kelzpugz. All rights reserved.
 Revised: 01/10/10 23:51:44 -0700.

 

KELZPUGZ AKC PUG BREEDER WESTERN NEW YORK