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Name:
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| Address: |
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| Email Address: |
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| Phone Number: |
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| Best time and way to reach you: |
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| Age I am interested in: |
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| Gender I am interested in: |
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| Have you owned a dog before? |
YesNo
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| If yes, what kind and do you still have them?: |
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| Do you own any other pets? |
YesNo
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| If yes, what kinds? |
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| How many people live in your home and what are their ages?: |
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| Please explain your housing situation (own, rent, house, condo apartment, etc...).: |
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| If you rent, may we contact your landlord to verify you may have a dog? |
YesNo
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Is your yard fenced?
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YesNo
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| If yes, what kind of fencing do you have and how tall is it?: |
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| Where will the dog sleep?: |
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| Will the dog be allowed on the furniture? |
YesNo
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| How many hours will the dog be left alone each day?: |
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| Where will the dog be kept when left alone?: |
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| What arrangements will be made for the dog if you go on vacation?: |
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| Please provide your veterinarian's name, address, & phone number.: |
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| Please describe the activities you plan to do with this dog (pet, showing, lure coursing, etc...). |
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| May we or a representative do a home visit with you? |
YesNo
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| May we share your information with other breeders? |
YesNo
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| Please provide any additional information you would like us to have.: |
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