| Name: | | |
| Address: | | |
| City, State, Zip Code: | | |
| Home Phone: | | |
| Cell Phone: | | |
| Email: | | |
| 1. How did you find us?( Please Be More Specific Than "The Internet" ): | | |
| 2. Do you own or rent your home? | | |
| 3. How many people are in the home? (please describe your family): | | |
| 4. Are there children in the home?: | | |
| 4a: If So: What ages?: | | |
| 4b: How are they with animals?: | | |
| 5. Do you have a fenced in yard? | | |
| 5a: If yes,what kind of fence? | | |
| 5b: If no,what are your plans regarding puppy? | | |
| 6. Do you have any other pets now?: | | |
| 6a: If so, Please describe: | | |
| 7. If you have other pets have they been spayed/neutered?: | | |
| 7a: If No, Why Not?: | | |
| 8. Have you ever given up a dog to a Shelter or Rescue?: | | |
| 9. Your vet's name and phone # ?: | | |
| 10. Who will be home during the day with the puppy? Please explain circumstances with some detail: | | |
| 11. About how many hours per day will the dog be left alone?: | | |
| 12.What breed are you Interested in?: | | |
| 13. Do you now or have you ever owned this breed before?: | | |
| 14. All Breeds have negative's, Please list 2 breed negative's for me: | | |
| 15. What gender do you prefer?: | | |
| 16.What age are you interested in?: | | |
| 17. What Color do you prefer?: | | |
| 18.What type of dog are you interested in: | | |
| 19.Do you plan on having your puppy spayed or neutered by 7 months of age?: | | |
| 20. Do you plan to attend obedience classes?: | | |
| 21. Are you familiar with grooming requirements?: | | |
| 22. Have you read and do you agree with my "Health Guarantee Contract"? | | |
| 23. Will you require the pup to be shipped to you?: | | |
| Comments, Questions, and Additional Information?: | | |
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