* Full Name

* Email

Phone Number

* Date

City, State & Zip

* Age

What other pets do you currently have?

Do you know the average length of a chinchilla's lifespan?

Why do you want this chinchilla?

* Have you ever owned a chinchilla before?

* Do you have a gender preference? (Please select from the list.) It doesn't matter. Male Female

* Will this chinchilla have a cagemate?

* What age are you looking for? (Please select from the list.) It doesn't matter. Kit (around 8 weeks+) Young Chin (Between 2 months and 1 year) Adult Chin(1 year or more) Rescue

* Do you have a color preference?** (Please select an option.) Standard Black Velvet White Mosaic White Ebony Hetero Beige Homo Beige Brown Velvet Tan Hetero Ebony Homo Ebony Violet Sapphire Other No Preference

Other Color

* Do you know of an exotic veterinarian?

What brand of feed do you plan on using?

* Do you have access to emergency vet funds if necessary?

How big is the cage you plan on using?

* Will you contact us if you need to re-home your chinchilla for any circumstance?

Comments, Questions or Concerns:

* Full Name & Date:

* Please enter the letters and numbers in the following box exactly as you see them.