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First name
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Last name
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Email
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Phone
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Do you own your own or rent?
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Own
Rent
Do you have other pets now?
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Yes
No
If yes, what do you have?
What breed are you interested in?
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Yorkie
Shorkie
Dorkie
Yorkiepom
Do you have kids living in the home?
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Yes
No
If yes, how old?
Best time to call?
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