First Name:                                       Last Name:    

    Address:                                           City:                       

    State:              State Arizona Arkansas California Colorado Florida Georgia Louisiana Kansas Kentucky Nebraska Nevada New Hampshire New Mexico New York North Dakota Maine Michigan Minnesota Missouri Montana Ohio Olklahoma Oregon Pennsylvania Rhode Island South Dakota Texas Tennesse Virginia Washington West Virginia Wyoming                                          Zip Code:      

    Phone                                               Email:             

    I Prefer to be contacted by   Please Select Phone Email

   Are you under 18 or older?  Please Select Yes No       If under 18 we will need to contact a parent/guardian for verbal confirmation.

General Info

   Current Pets:

       Cats:     0 1 2 3 4 5                 

       Dogs:    0 1 2 3 4 5

       Other:   0 1 2 3 4 5

Rat Preference

   Breed of Rat:         Please Select Any Blue Dumbo Naked Unsure                           Color            Please Select Any Blonde Brown Dark Brown Hooded Light Brown Hooded White Unsure

    Additional information you would like to inquire about a rat:

Rat Questions

   Have you ever owned a Rat ?           Select Yes No     

   Rats currently own.            None 1 2 3 4 5+

   I would like more information pertaining to the care and nutrition.               Select Yes No

   Please type below any specific questions that you have:

If you would like to help provide nutrition, medical, and shelter for the Rats.                       

If you would prefer in sending supplies needed, please contact us by email and we will set up arrangements.