DATE:

FULL NAME


ADDRESS


CITY, STATE & ZIP CODE


PHONE NUMBER


WHAT IS YOUR EMAIL ADDRESS?
(Don't forget @ what/example ME@AOL.COM)


COLOR OF PUPPY WANTED


SEX OF PUPPY WANTED


1. In What type of housing do you live?
Apartment
Condo
One Family
Other
If other explain


2.Do YouOwn Rent
If renting, does the landlord allow pets?


3. Fenced in yard? YesNo
Height of fence


4. Household make-up?
Number of Adults
Children
Pets
Ages of child(s)

5. Who will be the major person responsible for the dog?


6. Does anyone have allergies to animals?


7. Does anyone have fear of dogs in the household?



8. How many hours a day will the pet be left home alone?


9. Do any neighbor's pets come into your yard?


10. Is the puppy being purchased as a surprised gift for anyone?


11. How close is your nearest neighbor?


12. Can we contact them?
YesNo
If not, Why?


13. If yes, please provide the name and phone number of your neighbor?


14. List one other personal reference and relationship (Unrelated).(Name and Phone Number)


15. Do you have a cat(s) or kitten(s)?YesNo
Is it an indoor or out?


16. Do you have other pets?YesNo
If dog, is it male or female?


17. List pets you have had and what happened to them?


18. List your vet's name and phone number (include last pets name the records are under).


19. Do you plan on spaying or neutering the dog?
YesNo

20. Where will the pet spend most of its time?


21. Are you willing to crate train?
YesNo

22. Can we visit your home?
YesNo

23. Will you give follow up reports?
YesNo

24. When will you be ready to take this puppy?


25. If for any reason whatsoever, do you agree to return this dog to us should things not work out AND NOT PLACE THE DOG ON YOUR OWN!


(PLEASE ANSWER ALL QUESTIONS AND HIT THE SUBMIT BUTTON)