Name: :
Address: :
City, State & Zip code: :
Phone Number: :
E-mail address: :
How did you find us? Referred by? :
Name, address & phone #'s of two people whom we may contact as personal references: :
Type of dwelling? :
Own or rent? :
Name, address & phone # of your Landlord: :
How long have you lived at this address? :
Name, address, & phone # of your veterinarian: :
How did you hear about this breed? :
What reference materials have you read? :
Do you have experience with this breed? :
Who will be the primary care giver? :
Where will the puppy be kept during the night? :
Where will the puppy be kept during the day? :
How many hours on the average will the puppy be left alone? :
Do you have other pets? If yes, what are they? :
Do you have children? If yes, what are their ages? :
How many hours a day will the puppy be kept outside? :
How will you keep the puppy confined when it's outside? :
Have you ever house trained a dog before? :
Will you be attending training classes? :
Are you interested in a male or female? :
Have you considered an older dog instead of a puppy? :
Are you interested in showing this dog in the conformation ring? :
Are you interested in competition in performance events such as obedience, agility or rally? :
Do you intend to breed this dog? :
Do you understand the difference between a limited registration and a full registration? :
How long did you last pet live? What were the circumstances of its' death? :
Have you ever returned a pet to the breeder? If so, what were the circumstances? :
Have you ever had to re-home a pet? If so, what were the circumstances? :
Have you ever taken a pet to the pound or shelter? If so , what were the circumstances? :
Are you a member of any animal related groups such as breed clubs, rescues, welfare organizations? :
Please type the text below :
