NAME:

ADDRESS:

EMAIL: WEBSITE:

HOME PHONE: CELL PHONE:

WORK PHONE:

REFERRED BY:

Do you have any other animals and what breeds?

Who will be responsible for the puppy?

Will this be an inside or outside dog?

How much time during the day will the dog be alone?

Will someone be available to feed and exercise the puppy during the day? Yes No

Do you have any children? If yes, what are their ages.

Where will the puppy be during the day and where will they sleep at night?

Does anyone in your household have allergies to animals? Yes No

Is your yard fenced yard and what size?

Do you intend to breed the dog? Yes No

Do you understand the difference between a limited registration and a full registration?
Yes No

Please describe your general life style:

Which describes your interests: Family Pet Show Breeding Obedience
Agility Other

Do you prefer a Male or Female puppy? Male Female

What type of personality/temperament are you looking for:

Which of our Breeds are you interested in?

Why did you choose this breed?

Are you familiar with the coat care the breed requires? Yes No

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